{"id":60569,"date":"2026-06-05T11:15:13","date_gmt":"2026-06-05T03:15:13","guid":{"rendered":"https:\/\/chonghua.com.ph\/?post_type=awsm_job_openings&p=60569"},"modified":"2026-06-05T11:23:02","modified_gmt":"2026-06-05T03:23:02","slug":"medical-claims-specialist","status":"publish","type":"awsm_job_openings","link":"https:\/\/chonghua.com.ph\/zh\/jobs\/medical-claims-specialist\/","title":{"rendered":"Medical Claims Specialist"},"content":{"rendered":"
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Job Summary <\/div><\/span>\n\t\t\t\t\t\t\t\n\t\t\t<\/i><\/span>\n\t\t\t<\/i><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t
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\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>

\u5d07\u534e\u533b\u9662\u6b63\u5728\u62db\u8058\u4e00\u4f4d\u7ecf\u9a8c\u4e30\u5bcc\u3001\u79ef\u6781\u4e3b\u52a8\u7684 Medical Claims Specialist<\/strong> is mainly responsible for reviewing and analyzing referred charts of discharged patients that may acquire attention and technical in nature. S\/he also assesses any denied claims caused by inconsistent data and non-compliance with standard of care. S\/he determines whether the denied claims are for appeal, thus, prepares an appeal letter. Moreover, s\/he prepares preliminary assessment of patient\u2019s chart pertaining to PhilHealth Insurance Corporation request for a verified letter. <\/span>\u00a0<\/span><\/p>

S\/he closely coordinates with\u00a0the\u00a0Medical Team for resolution of problematic charts.\u00a0S\/he serves as a medical representative that\u00a0supports and\u00a0provides\u00a0clarification to the\u00a0Philhealth\u00a0and\u00a0Quality Records\u00a0team in relation to\u00a0reading charts and verifying claims.\u00a0One of her\/his essential roles is\u00a0to train the Consultant and Resident Doctors on PhilHealth concepts and rules.\u00a0S\/he is also expected to\u00a0assist\u00a0in planning and executing claims improvement initiatives and\u00a0submit\u00a0timely\u00a0and\u00a0accurate\u00a0reports\u00a0of medical claims.<\/span>\u00a0<\/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

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  • Review medical claims to ensure company reimbursement payments are\u00a0accurate\u00a0and\u00a0reprice\u00a0claims according to hospital payment schedules\u00a0and reimbursements.<\/span>\u00a0<\/span><\/li><\/ul>
    • Negotiate claim settlements and make recommendations for legal action when settlements are\u00a0deemed\u00a0non-negotiable.<\/span>\u00a0<\/span><\/li><\/ul>
      • Reject or accept documentation,\u00a0determine\u00a0benefit due, and start the denial or payment process to resolve medical claims.<\/span>\u00a0<\/span><\/li><\/ul>
        • Maintains updated records and prepares required documentation to support the insurance claims.<\/span>\u00a0<\/span><\/li><\/ul>
          • Provide excellent customer service when working with customers and hospitals to resolve insurance claim issues, answer questions, and\u00a0provide\u00a0solutions to other problems related to medical claims.<\/span>\u00a0<\/span><\/li><\/ul>
            • Responsible for creating\u00a0timely\u00a0and\u00a0accurate\u00a0reports on medical claims and appeals.<\/span>\u00a0<\/span><\/li><\/ul>
              • May be assigned in a project that aims to improve\u00a0specific areas,\u00a0working independently or with a cross-functional team.\u00a0May be tasked to make necessary recommendations on performance of team members or cross-functional team member.\u00a0<\/span>\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
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                \u8d44\u683c <\/div><\/span>\n\t\t\t\t\t\t\t\n\t\t\t<\/i><\/span>\n\t\t\t<\/i><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t
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                • A graduate of\u00a0any\u00a0bachelor\u2019s\u00a0degree,\u00a0\u00a0<\/span>\u00a0<\/span><\/li><\/ul>
                  • A minimum of\u00a0five\u00a0to\u00a0seven\u00a0(5-7) years of relevant work experience\u00a0in\u00a0medical field and with background in claims management<\/span>\u00a0<\/span><\/li><\/ul>
                    • Healthcare\u00a0industry\u00a0experience is a plus.\u00a0<\/span>\u00a0<\/span><\/li><\/ul>
                      • Comprehensive knowledge of insurance plans, member eligibility, and medical billing<\/span>\u00a0<\/span><\/li><\/ul>
                        • Strong background in government and commercial payers<\/span>\u00a0<\/span><\/li><\/ul>
                          • Understands\u00a0medical terminologies<\/span>\u00a0<\/span><\/li><\/ul>
                            • \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\u00a0<\/span>\u00a0<\/span><\/li><\/ul>
                              • Excellent communication skills.\u00a0Proficiency\u00a0in the Visayan dialect and\/or Tagalog is\u00a0required.<\/span>\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":"

                                Job Summary Make a difference and advance your career with Chong Hua Hospital, the Philippines’ premier healthcare destination! Chong Hua Hospital is looking to hire an experienced and highly motivated Medical Claims Specialist is mainly responsible for reviewing and analyzing referred charts of discharged patients that may acquire attention and technical in nature. S\/he also […]<\/p>","protected":false},"author":5,"template":"","meta":{"_acf_changed":false},"class_list":["post-60569","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":"\nMedical Claims 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\/medical-claims-specialist\/\" \/>\n<meta property=\"og:locale\" content=\"zh_CN\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Medical Claims 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’ premier healthcare destination! Chong Hua Hospital is looking to hire an experienced and highly motivated Medical Claims Specialist is mainly responsible for reviewing and analyzing referred charts of discharged patients that may acquire attention and technical in nature. 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