Medical Officer (Experience With Medical Claims) for Medical Industry/Salary: 15,000 - Plus 3,000 Allowance/Brgy. Poblacion, Makati

Offer description

1. Responsible for the enrollment of corporate account and members in the system including the set-up of
benefits.
2. Serves as the point of contact for members, providers, corporate accounts for availment assistance and
other availment related concerns.
3. Process admissions and ensure that verification of coverability (COV) is conducted within 24 hours.
4. Process and provides approval on the request for Letter of Authorization (LOA) for outpatient consult,
laboratory, emergency, OPD-OR and clinic setting as long it is within the member’s benefit limit and not
part of the exclusions.
5. Performs claims adjudication for inpatient within 30 minutes once the member is for discharge and
complete medical documents are provided.
6. Coordinates with the corporate account requiring pre-approval prior the issuance of LOA.
7. Screen and process medical reimbursement per member/corporate account endorsement.
8. Process receives medical claims from the providers based on the approved LOA during availment to
facilitate the payment.
9. Process doctor’s enrollment and updating of CPT rates in the system.
10. Liaise and process APE request of the corporate accounts
11. Attend to customer service request from mobile app and chats from AMAPHIL Facebook account and
website.
12. Prepares and submits weekly transaction reports.
13. Carry out ad hoc assignment
QUALIFICATIONS:
1. Graduate of nursing or any medical allied/related course
2. With at least 2 years of relevant experience in medical claims processing.
3. With good communication skills both written and verbal
4. Knowledgeable on MS office applications e.g. excel, word and ppt

Requirements

• Minimum education level: Bachelor´s Degree
• 2 years of experience
• Language(s): English
• Knowledge: Microsoft Excel, Microsoft PowerPoint, Microsoft Word

More than 30 days ago

About Dempsey, Inc.

We strive to become a significant venue both for private companies and professionals for the purpose of matching their respective needs, creating opportunities for productive, meaningful and long-term employment.

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