Job description
Unilab, a leading pharmaceutical and health solutions company in the Philippines, is seeking a dedicated Claims Officer to join our growing operations team in Mandaluyong City. This role oversees day-to-day claims processing across all insurance lines, ensuring accuracy, timely adjudication, and strict compliance with internal policies and regulatory requirements. The ideal candidate thrives in a fast-paced environment, demonstrates strong analytical skills, and places a premium on delivering exceptional service to clients, providers, and partners.
As a Claims Officer, you will be responsible for supervising the end-to-end claims lifecycle—from intake and validation to adjudication, payment, and resolution. You will collaborate with underwriting, healthcare providers, third-party administrators, and internal stakeholders to resolve complex or ambiguous claims, minimize risk, and optimize claim turnaround times. You will also help develop and monitor performance metrics, identify process improvements using data-driven insights, and contribute to policy interpretation and updates to reflect evolving regulations and market practices.
We value candidates who are detail-oriented, systems-savvy, and customer-focused. A successful candidate will demonstrate integrity, effective communication, and the ability to balance quality control with speed. This is a full-time position based in Mandaluyong City with opportunities for professional growth within Unilab, a respected name in Filipino health and wellness.
Key responsibilities include governing claims processing standards, ensuring proper documentation, compliance with privacy laws, monitoring for potential fraud indicators, and preparing accurate management reports for leadership and regulators. You will mentor junior staff, lead claims training sessions, and maintain strong relationships with internal customers and external partners.
Responsibility
- Oversee daily claims processing across all insurance lines to ensure accuracy, timeliness, and compliance.
- Review, adjudicate, and authorize claims in accordance with policy terms, client contracts, and service levels.
- Collaborate with underwriting, providers, and third-party administrators to resolve complex or ambiguous claims.
- Manage claims queue and SLA adherence; monitor turnaround times and implement process improvements.
- Ensure robust documentation, data integrity, and accurate reporting for audits and regulators.
- Lead, train, and coach the claims team; set performance goals and review progress.
- Monitor for potential fraud indicators and ensure risk management controls.
- Escalate and resolve customer or partner inquiries with a focus on service excellence.
Qualification
- Bachelor's degree in Business Administration, Healthcare Administration, Insurance, or related field.
- 3-5 years of experience in claims processing, adjudication, or related insurance operations; healthcare insurance preferred.
- Strong knowledge of insurance policies, claims adjudication, and regulatory compliance in the Philippines (Insurance Commission, data privacy).
- Proficiency with claim management systems, data analytics tools, and MS Office.
- Excellent communication, negotiation, and stakeholder management skills.
- Experience in people management or team leadership is a plus.
- Detail-oriented with strong analytical and problem-solving abilities.