Claims Processing Specialist I Medical Adjudicator
StayWell Information Systems, Inc.
- Quezon City, Philippines16TH FLR RM 1602, E. Rodriguez Sr. Ave, Kalusugan, Quezon City, Metro Manila, PhilippinesQuezon CityMetro ManilaPhilippinesPhilippines
- ₱25,000.00 - ₱30,000.00 / monthPHP250003000025000MONTH
- Full timeFULL_TIME
Posted 9 days ago and deadline of application is on 6 Apr
Recruiter was hiring 5 days ago
2026-03-26T08:01:37.884234+00:002026-04-06T16:00:00+00:00Job Description
- Review and evaluate data on claim forms and supporting documents.
- Process for payment on- and off-island medical, dental, and pharmacy claims.
- Review and verify authorized charges on claim statements.
- Prepare correspondence to providers regarding billing issues and benefit coverage.
- Handle data entry of medical, dental and pharmacy claims into the computer for processing.
- Re-evaluate evidence and obtain additional information in connection with claims pended, denied or under appeal.
- Ensure that all claims and payments are reconciled.
- Coordinate daily activities, including handling of complaints, with various departments such as enrollment and customer care.
- Ensure participation to various company programs, activities and committees, such as but not limited to training and development programs, collegial planning, collaborative ad-hoc projects, and other company-sponsored events, as necessary;
- Adhere to all set Organization policies, procedures and standards, and promote culture of compliance and continuous improvement among the existing manpower pool.
- Adhere to all policies, procedures and standards set by the company, and help promote the culture of compliance and continuous improvement within the Organization.
- Perform job functions consistent with the company's vision and mission statements, and core values.
- Perform other duties, roles and responsibilities analogous, related, similar, germane and/or implied to the above-mentioned
Minimum Qualifications
- Bachelor’s degree in Nursing, Pharmacy, Dentistry or any allied medical field
- At least one (1) year of work experience in health insurances
- Computer literate, preferably with working knowledge in using MS Office Suite (Word, Excel, PPT, etc.)
- Knowledge on basic medical terminology
- Knowledge in medical/dental claims procedures
- Ability to solve basic claim issues and concerns
- Basic business communication skills
- Knowledge of basic accounting principles
Perks and Benefits
Retirement Benefit Plans
Special Leave Benefits for Women
Single Parent Leave
Life Insurance
Medical / Health Insurance
Paid Sick Leave
Paid Bereavement/Family Leave
Paid Holidays
Paid Vacation Leave
Maternity & Paternity Leave
Medical, Prescription, Dental, or Vision Plans
Other
De Minimis Benefits (Rice Subsidy, Cloting Allowance, Laundry Allowance, Pharmacy Benefits)
Required Skills
- Medical Industry Knowledge
- Complex Problem-Solving
- Quality Assurance
- Attention to Detail
- Problem Solving
- Critical Thinking
- Monitoring and Evaluation
Preferred Courses
- Nursing
- Pharmacy
- Dentistry
Jobs Summary
- Job Level
- Entry Level / Junior, Apprentice
- Job Category
- Health and Medical
- Educational Requirement
- Bachelor's degree graduate
- Recruiter response to application
- Often
- Office Address
- RM 1602 NORTH TOWER CATHEDRAL HEIGHTS BLDG. COMPLEX ST. LUKES MEDICAL CENTER E. RODRIGUEZ SR. AVE. 1112 QUEZON CITY, PHILIPPINES
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About StayWell Information Systems, Inc.
StayWell Information Systems, Inc. (SISI) is a branch office of a Guam-based Corp.; a US based company and a health and auto insurance provider in Guam since 1982. We currently serve quality and affordable insurance coverage to private business employees, and families in Guam and the Commonwealth of the Northern Marianas Islands.