1. Process enrollment transactions, including receiving, logging, screening, verifying, and coding data for input into the enrollment system(s) based on department policies and group/individual policy contracts.
2. Handle premium A/R requests per established department guidelines.
3. Collect group premiums, address receivables, and issue collection notices, maintaining accounts within required time frames.
4. Educate members and employers on plan guidelines, eligibility updates, and the premium collection process.
5. Conduct aging analysis, review revenue/eligibility reports, and resolve receivable balances through collection efforts or revenue adjustments.
6. Resolve day-to-day issues in Membership Accounting and Enrollment operations, including member/dollar-level account reconciliation, auditing, and billing adjustments.
7. Perform data entry of approved enrollment requests and premium payments when needed.
8. Support the department in meeting or exceeding performance metric targets and goals.
9. Assist the department supervisor with new priorities and opportunities from managing partners.
10. Conduct MAS audit functions.
11. Complete special projects as assigned in a timely manner.
12. Perform other duties as assigned.

1. Associate degree or equivalent two-year course, or a minimum of three years' experience in customer service resolving eligibility and premium accounts receivable issues.
2. Flexibility to work evenings and weekends.
3. Effective team player with strong interpersonal skills.
4. Ability to address complex situations with maturity, diplomacy, and tact, especially when dealing with irate customers.
5. Excellent oral and written communication skills.
6. High level of personal and professional integrity with strong ethics.
7. Basic knowledge of federal and state healthcare laws and regulations.
8. Proficient in MS Office programs and general computer literacy.

Location: Manila, Metro Manila, Philippines

Duties and Responsibilities:

1. Reviews, codes, bills and collects on all services provided at the clinic (Medical, Dental, Vision, Home Health), hospital and birthing center and posts payments received for those services.
2. Makes sure that insurance claim forms (CMS1500) and patient billing statements are sent out on a timely manner to ensure optimal reimbursement and payment while adhering to regulations.
3. Issues collection notices to insurance companies and patients with delinquent account balances.
4. Performs other duties that may be assigned from time to time.

Job Specifications:

1. Graduate of Bachelor’s Degree. License is not required.
2. Minimum of one year experience in billing and collection and ensuring that overall revenue base goals are met through strategic collection efforts of all unsettled and delinquent accounts within TakeCare/FHP Health Center.
3. Effective team player.
4. Excellent interpersonal skills, can work and relate well with co-employees, patients and customers.
5. Must have the behavioral sensitivity, maturity, diplomacy and tact in addressing complex situations and handling irate customers.
6. Outstanding oral and written communication skills.
7. Strong ethics and a high level of personal and professional integrity.
8. Must have basic familiarity with federal and state laws and requirements relating to healthcare management.
9. Proficient in using MS Office programs.

Education & Experience:

1. Graduate of Bachelor’s Degree in Mathematics, Applied Mathematics, Actuarial Science, Statistics or any equivalent.
2. Must have at least three (3) years health insurance Actuarial and Underwriting experience.
3. Must have passed at least two (2) Actuarial or Underwriting certification and/or examination.
4. Must have the capability to initiate, organize and manage actuarial/underwriting projects independently. Also responsible for conducting research health care cost trends and applying actuarial analysis and techniques to arrive at recommended ways to reduce health care costs.
5. Superior judgment, negotiation and decision-making skills.
6. Strong ethics and a high level of personal and professional integrity.
7. Strong analytical skills and adept in interpreting strategic vision into an operational and tactical model.
8. An effective communicator with strong oral, written and persuasive skills and capability to deal with people at all levels in the organization.
9. Computer literate and very highly proficient in using MS office programs.