Claims Benefit Manager
Hive Health(2 months ago)
About this role
The Claims Benefit Manager at Hive Health leads medical adjudication operations, ensuring claims are accurately processed in compliance with policies and regulations. This role oversees a team of medical liaisons, drives process improvements, and works cross-functionally with various departments to enhance the claims experience for members and providers. Key responsibilities include managing daily operations, conducting audits for accuracy, identifying potential fraud, and monitoring performance metrics to implement corrective measures.
Required Skills
- Claims Management
- Team Leadership
- Adjudication Operations
- Quality Assurance
- Process Improvement
- Data Analysis
- Cross-Functional Collaboration
- Stakeholder Management
- Fraud Investigation
- Regulatory Compliance
Qualifications
- Bachelor’s degree in nursing, healthcare management, business, or a related field
About Hive Health
ourhivehealth.comHive Health is a digital platform providing accessible and affordable Health Maintenance Organization (HMO) plans tailored specifically for small to medium enterprises (SMEs) in the Philippines. Focused on enhancing employee wellness, the platform offers a comprehensive range of benefits including teleconsultations, mental health services, and various healthcare coverages through an extensive network of accredited hospitals and clinics. With an emphasis on user-friendly technology, Hive Health simplifies health insurance management for both employees and HR teams, promoting a healthier and more productive workplace.