Claims Adjudicator

A Claims Adjudicator plays a crucial role in evaluating and processing insurance claims, disability benefits, or other financial claims. Their qualifications and responsibilities vary slightly depending on the industry (e.g., insurance, healthcare, government benefits), but heres a comprehensive overview:

Qualifications

To become a Claims Adjudicator, typical requirements include:

Education:

• A bachelors degree in business administration, insurance, healthcare, or a related field may be preferred for advanced positions.

Experience:

• Previous experience in customer service, claims processing, or administrative roles is beneficial for at least 6 months of experience.
• Some industries may require specialized experience (e.g., medical knowledge for healthcare claims).

Skills:

• Strong analytical and critical thinking abilities.
• Excellent attention to detail.
• Knowledge of insurance policies, healthcare regulations, or legal requirements.
• Proficiency in relevant software for claims management.

Responsibilities

A Claims Adjudicators tasks typically include:

Claim Evaluation:

• Reviewing submitted claims for completeness and accuracy.
• Verifying supporting documents such as medical records, police reports, or invoices.

Investigation:

• Contacting claimants, witnesses, or medical providers for additional information.
• Investigating potential fraud or discrepancies.

Decision-Making:

• Determining claim validity based on policy terms and guidelines.
• Approving or denying claims accordingly.

Calculations and Payments:

• Calculating payout amounts based on policy coverage.
• Ensuring accurate and timely claim payments.

Compliance and Documentation:

• Ensuring all decisions comply with relevant laws and organizational policies.
• Maintaining thorough records of claim decisions, communications, and supporting documentation.

Customer Service:

• Explaining decisions to claimants and answering inquiries.
• Providing clear instructions on the next steps for accepted or denied claims.

Job Types: Full-time, Permanent

Pay: Php25,000.00 - Php35,000.00 per month

Benefits:

• Flexible schedule
• Paid training

Schedule:

• 8 hour shift
• Monday to Friday
• Overtime

Supplemental Pay:

• 13th month salary
• Overtime pay

Work Location: In person