claims benef it ManagerHive Health

Ready to make an impact? At Hive Health and HPPI, a subsidiary of , we're on a mission to make healthcare radically more accessible for all-and we need passionate, driven individuals to help us make it happen. If you thrive in a fast-paced, innovative environment and want to work on solutions that truly matter, we'd love to meet you!About the RoleAs the Claims Benefit Manager, you will lead Hive's medical adjudication operations to ensure claims are reviewed accurately, efficiently, and in alignment with policies and regulatory standards. You'll oversee a team of medical liaisons responsible for evaluating claims, managing provider coordination, and maintaining quality and compliance across the process.This is both a strategic and hands-on leadership role. You'll drive continuous process improvements, coordinate across departments such as Adjudication, Legal, and Provider Partnerships, and play a key part in shaping how Hive delivers fast, fair, and reliable claims experiences to its members and providers.ResponsibilitiesLead and manage the medical liaisons team to meet accuracy, quality, and service targetsOversee daily adjudication operations to ensure claims are processed efficiently and in compliance with policy guidelinesConduct audits to ensure claims accuracy, completeness, and consistency with internal standardsIdentify potential cases of fraud, waste, or abuse (FWA) and coordinate investigations with Legal and ComplianceWork cross-functionally with Claims, Provider Partnerships and Healthcare Services to address recurring operational issuesMonitor key metrics such as turnaround time, quality scores, and error rates, and implement corrective measures as neededDrive continuous process improvements to enhance provider and member experience in the claims processQualificationsBachelor's degree in nursing, healthcare management, business, or a related fieldAt least 5 years of experience in operations, healthcare administration, or team managementStrong analytical and problem-solving skills, with a focus on process improvementExperience leading teams and driving performance in fast-paced environmentsComfortable working with data, reports, and digital systems to track metrics and quality outcomesExcellent communication and stakeholder management skills across both medical and non-medical teamsJoin our team as we revolutionalize healthcare in the Philippines-and beyond!✨ Day 1 benefits for full-time employees - because we practice what we preach! Enjoy comprehensive healthcare coverage for you and your dependent, and paid time off from the start.
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Hive Health

Pasig City, Metro Manila
Permanent
Full-time