Claims Intake Senior Specialist

Job Description

The Opportunity

Are you passionate about working with customers, building relationships, and being part of a growing business? Then we would love to have you join our Long-Term Care team as a Claims Intake Senior Specialist! With the customer as the focus, this role will take a proactive approach to every customer interaction, to ensure a high-quality experience. This role is primarily accountable for assisting customers with initiating a claim, educating them on our claims process, and promoting digital self-service features. How will you create impact? As a Claims Intake Senior Specialist, you will belong to a specialized team that provides concierge service to a targeted segment of our customers during the claim process. You will ensure and gather all company, legal and regulatory requirements to process claims while maintaining the highest level of professionalism and customer satisfaction.

On the Job, you will (Responsibilities):

✅ Initiate all aspects of the medical claims process
✅ Review policy information and benefit eligibility criteria to determine if it is the right time to initiate a claim
✅ Determine appropriate requirements, analyze, and interpret medical claims documentation, policy contract wording, and in-force policy documentation to determine whether the submission is valid with the correct benefit amount and beneficiary designation
✅ Provide a top-notch customer experience
✅ Performing a robust intake process and completing the claim initiation on the customer’s behalf
✅ Addressing medical claims concerns, educating clients about the process to set proper expectations
✅ Promoting digital options including online registration, virtual assessments, direct deposit, etc.
✅ Conduct follow-up callouts or communicate via email
✅ Promote potential wellness opportunities prior to the claim
✅ Capture accurate, complete, and important claims information into a record
✅ Follow strict procedures for privacy and transaction processing

What motivates you?

✅ You obsess about customers, listen, engage, and act for their benefit.
✅ You think big, with curiosity to discover ways to use your agile approach and enable business outcomes.
✅ You thrive in teams and enjoy getting things done together.
✅ You take ownership and build solutions, focusing on what matters.
✅ You do what is right, work with integrity and speak up.
✅ You share your humanity, helping us build a diverse and inclusive work environment for everyone

What we are looking for someone with (QUALIFICATIONS):

✅ US Registered Nurses

✅ Bachelor’s Degree in Nursing

✅ Clinical nursing or claims processing experience is an advantage

✅ UP Ayalaland Technohub in Quezon City OR Mactan Newtown in Cebu

Work Arrangement:
✅ Hybrid

✅ Excellent English skills


✅ Adaptability – quick study; agile and flexible to any situation
✅ Customer Focus and Building Rapport – Manage customers while demonstrating patience and empathy
✅ Analytical and Decision-Making skills – analyze cases and claims, identify if valid, and provide recommendations
✅ High level of Attention to detail

What can we offer you?

✅ A competitive compensation package.
✅ A growth trajectory that extends upward and outward, encouraging you to follow your passions and learn new skills.
✅ A focus on growing your career path with us.
✅ Flexible work policies and strong work-life balance.
✅ Professional development and leadership opportunities.

Job Category: Insurance Operations
Job Type: Full Time
Job Location: Hybrid Philippines

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