Claims Processing Specialist (Travel Insurance)

Work Arrangement: On-site | Dayshift | Monday–Friday Location: Muntinlupa City Employment Type: Full-time Job Summary: The Claims Processor is responsible for the efficient processing, management, and resolution of claims. Ensures accurate documentation, communication, and adherence to company policies and procedures while assisting clients with their claims request. Key Responsibilities:

1. Claims Data Entry: Input claim data into the system, ensuring all information is accurate, up-to-date, and properly filed.
2. Claims Documentation: Assist in collecting and organizing all necessary documentation for claims, including medical reports, receipts, and forms.
3. Claim Processing: Review and assess claims to determine their validity, ensuring all necessary documentation is submitted and in compliance with relevant regulations.
4. Claims Review: Analyze claims data to identify discrepancies, fraud, or errors and escalate complex claims to senior claims staff or managers.
5. Investigation: Conduct initial investigations when necessary to gather additional information or verify claims details.
6. Compliance: Ensure compliance with industry regulations, company policies, and procedures in handling claims.
7. Claims Follow-up: Follow up with claimants, healthcare providers, or third-party vendors to ensure timely resolution and payment.
8. Coordination: Communicate with various departments, such as underwriting, legal, or customer service, to facilitate smooth claims processing.
9. Customer Support: Serve as a point of contact for customers or policyholders, answering inquiries related to claims status, processing timelines, and required documentation.
10. Documentation Management: Maintain accurate records of claims, correspondence, and claims history in the system.

• Bachelor’s degree in any related field.
• Previous experience in claims processing, customer service, or a related field is preferred.
• Strong organizational and communication skills.
• Ability to handle confidential information with discretion.
• Familiarity with claims software or management systems.
• Attention to detail and accuracy.
• Knowledge of industry-specific regulations and compliance standards (e.g., insurance or healthcare claims).

• Problem-solving and critical thinking skills to resolve complex claims issues.
• Ability to work both independently and as part of a team.
• Strong analytical skills to assess claims data effectively.
• Excellent written and verbal communication skills.