{"id":60544,"date":"2026-06-05T10:27:55","date_gmt":"2026-06-05T02:27:55","guid":{"rendered":"https:\/\/chonghua.com.ph\/?post_type=awsm_job_openings&#038;p=60544"},"modified":"2026-06-05T10:45:45","modified_gmt":"2026-06-05T02:45:45","slug":"claims-review-specialist","status":"publish","type":"awsm_job_openings","link":"https:\/\/chonghua.com.ph\/zh\/jobs\/claims-review-specialist\/","title":{"rendered":"Claims Review Specialist"},"content":{"rendered":"<div data-elementor-type=\"wp-post\" data-elementor-id=\"60544\" class=\"elementor elementor-60544\" data-elementor-post-type=\"awsm_job_openings\">\n\t\t\t\t<div class=\"elementor-element elementor-element-372b8bd e-flex e-con-boxed e-con e-parent\" data-id=\"372b8bd\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5a2950e elementor-widget elementor-widget-n-accordion\" data-id=\"5a2950e\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;default_state&quot;:&quot;expanded&quot;,&quot;max_items_expended&quot;:&quot;one&quot;,&quot;n_accordion_animation_duration&quot;:{&quot;unit&quot;:&quot;ms&quot;,&quot;size&quot;:400,&quot;sizes&quot;:[]},&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"nested-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"e-n-accordion\" aria-label=\"\u624b\u98ce\u7434\u3002\u4f7f\u7528 Enter \u6216 Space \u6253\u5f00\u94fe\u63a5\uff0c\u4f7f\u7528 Esc \u5173\u95ed\u94fe\u63a5\uff0c\u5e76\u4f7f\u7528\u7bad\u5934\u952e\u5bfc\u822a\">\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-9450\" class=\"e-n-accordion-item\" open>\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"1\" tabindex=\"0\" aria-expanded=\"true\" aria-controls=\"e-n-accordion-item-9450\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> Job Summary <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><i aria-hidden=\"true\" class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t<span class='e-closed'><i aria-hidden=\"true\" class=\"fas fa-plus\"><\/i><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-9450\" class=\"elementor-element elementor-element-1c02791 e-con-full e-flex e-con e-child\" data-id=\"1c02791\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0eb9266 elementor-widget elementor-widget-text-editor\" data-id=\"0eb9266\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"margin: 0px 0px 21px; font-size: 14px; text-align: justify; font-family: Poppins; font-weight: 400; letter-spacing: normal; text-transform: none; font-style: normal; color: #231f20;\">\u5728\u83f2\u5f8b\u5bbe\u9996\u5c48\u4e00\u6307\u7684\u533b\u7597\u4fdd\u5065\u4e2d\u5fc3\u5d07\u534e\u533b\u9662\uff0c\u53d1\u6325\u5f71\u54cd\u529b\uff0c\u63d0\u5347\u60a8\u7684\u804c\u4e1a\u751f\u6daf\uff01<\/p><p style=\"margin: 0px 0px 21px; font-size: 14px; text-align: justify; font-family: Poppins; font-weight: 400; letter-spacing: normal; text-transform: none; font-style: normal; color: #231f20;\">\u5d07\u534e\u533b\u9662\u6b63\u5728\u62db\u8058\u4e00\u4f4d\u7ecf\u9a8c\u4e30\u5bcc\u3001\u79ef\u6781\u4e3b\u52a8\u7684 <span data-contrast=\"auto\"><span style=\"font-weight: bold;\">Claims Review Specialist<\/span> who ensures that claims documents are in compliance with Philhealth circular and advisories. S\/he ensures that there are no deficiencies, fraud, error on the submitted clinical records or pertinent documents for claims. Moreover, s\/he works closely with the medical and other hospital staff for the resolution of problematic charts.<\/span><span data-contrast=\"auto\">\u202f<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559685&quot;:90,&quot;335559739&quot;:0,&quot;335559740&quot;:264}\">\u00a0<\/span><\/p><p style=\"font-size: 14px; text-align: justify; font-family: Poppins; font-weight: 400; letter-spacing: normal; text-transform: none; font-style: normal; color: #231f20;\"><span data-contrast=\"auto\">\u202f<\/span><span data-contrast=\"auto\">\u202f<\/span> <span data-contrast=\"auto\">Additionally, s\/he is expected to be knowledgeable about multiple PhilHealth benefits and claims management process (e.g inpatient benefits, outpatient benefits, Z benefits). S\/he must also be competent in maintaining quality customer services towards patients, and patients\u2019 significant others. Furthermore, s\/he is entrusted to being capable of organizing patient records as needed with the process as well as maintaining strict confidentiality with handled documents.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-9451\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"2\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-9451\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> \u5de5\u4f5c\u804c\u8d23\u548c\u8d23\u4efb  <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><i aria-hidden=\"true\" class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t<span class='e-closed'><i aria-hidden=\"true\" class=\"fas fa-plus\"><\/i><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-9451\" class=\"elementor-element elementor-element-2dc9141 e-con-full e-flex e-con e-child\" data-id=\"2dc9141\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4584d94 elementor-widget elementor-widget-text-editor\" data-id=\"4584d94\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li><span data-contrast=\"auto\">Receives claims form and countercheck with transmittal list provided \/ submitted.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559737&quot;:720,&quot;335559739&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/li><li><span data-contrast=\"auto\">Checks for completeness of data and the required supporting documents attached.<\/span><\/li><li><span data-contrast=\"auto\">Processes documents in relation implementing guidelines and procedures pertaining to PhilHealth benefits claims.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559737&quot;:720,&quot;335559739&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/li><li><span data-contrast=\"auto\">Ensure completeness of documentary requirements in the claims applications before forwarding to the next processing stage.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559737&quot;:720,&quot;335559739&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/li><li><span data-contrast=\"auto\">Verify\/validate information declared in the database to ensure correctness.<\/span><\/li><li><span data-contrast=\"auto\">Check the number of encoded claims and verify the accuracy of encoded\u00a0information in the List of Claims Received.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559737&quot;:720,&quot;335559739&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-9452\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"3\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-9452\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> \u8d44\u683c <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><i aria-hidden=\"true\" class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t<span class='e-closed'><i aria-hidden=\"true\" class=\"fas fa-plus\"><\/i><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-9452\" class=\"elementor-element elementor-element-3d20689 e-con-full e-flex e-con e-child\" data-id=\"3d20689\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9277239 elementor-widget elementor-widget-text-editor\" data-id=\"9277239\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li><span data-contrast=\"auto\">A graduate of any bachelor\u2019s degree.\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:264}\">\u00a0<\/span><\/li><li><span data-contrast=\"auto\">Possibly with at least three (3) years of relevant work experience in Hospital records management and insurance claims management.<\/span><\/li><li><span data-contrast=\"auto\">\u6709\u533b\u7597\u4fdd\u5065\u884c\u4e1a\u7ecf\u9a8c\u8005\u4f18\u5148\u3002<\/span><\/li><li><span data-contrast=\"auto\">Knowledgeable with medical terminologies.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:264}\">\u00a0<\/span><\/li><li><span data-contrast=\"auto\">Possibly an ICD 10 encoder\u202f<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:264}\">\u00a0<\/span><\/li><li><span data-contrast=\"auto\">\u8bc1\u660e\u5bf9\u57fa\u672c\u4f01\u4e1a\u529e\u516c\u8f6f\u4ef6\uff08\u5305\u62ec Microsoft Office 365 \u5e94\u7528\u7a0b\u5e8f\uff09\u7684\u4e86\u89e3\u3002<\/span><\/li><li><span data-contrast=\"auto\">Good communication skills. Proficiency in the Visayan dialect and\/or Tagalog is required; ability to communicate\u00a0well\u00a0in English is an advantage.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:264}\">\u00a0<\/span><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Job Summary Make a difference and advance your career with Chong Hua Hospital, the Philippines&#8217; premier healthcare destination! Chong Hua Hospital is looking to hire an experienced and highly motivated Claims Review Specialist who ensures that claims documents are in compliance with Philhealth circular and advisories. S\/he ensures that there are no deficiencies, fraud, error [&hellip;]<\/p>","protected":false},"author":5,"template":"","meta":{"_acf_changed":false},"class_list":["post-60544","awsm_job_openings","type-awsm_job_openings","status-publish","hentry","job-category-support-group","job-type-full-time","job-location-cebu-city"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Claims Review Specialist - Chong Hua Hospital - Official Website<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/chonghua.com.ph\/zh\/jobs\/claims-review-specialist\/\" \/>\n<meta property=\"og:locale\" content=\"zh_CN\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Claims Review Specialist - Chong Hua Hospital - Official Website\" \/>\n<meta property=\"og:description\" content=\"Job Summary Make a difference and advance your career with Chong Hua Hospital, the Philippines&#8217; premier healthcare destination! 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