MediCard Phils., Inc. is one of the country's leading HMO and the only HMO founded and run by Doctors. Since its inception, the concept of service-oriented total health care has been the molding ideal of MediCard. The competition is vast, and the benefits being offered by the competitors are tempting. However, MEDICard has taken the lead in providing innovative and productive ideas that cut down the cost of health maintenance without compromising its quality.
MediCard now boasts of more than half a million members and over 54,000 accredited doctors in over 1,000 hospitals and clinics nationwide. It also operates 16 MediCard free-standing clinics that provide services at par with those offered by hospitals minus the confinement.
MediCard is currently looking for assertive, dynamic and energetic individuals to fill up the following vacancy:
Conducts data analysis to provide insights, create meaningful reports by working on various data sources, employs statistical methods as applicable and communicates findings effectively; collaborates with the rest of the team to establish gameplan that will help achieve business goals.
DUTIES & RESPONSIBILITIES
• Focus on analyzing claims specific data on behaviors, trends and measuring performance and other relevant data and coordinates relevant information with the Claims Excellence Manager
• Responsible for analyzing inquiries related to Claims data
• Responsible for generating Claims reports requested from the department and creating data request of relevant data fields needed from IT
• Responsible for generating regular monthly and weekly reports of the department from the raw data provided by the different sections and submitting them to the Claims Excellence Manager for review
• Works with QA Supervisor to generate and analyze ISO and audit reports required from the department and submits them to Claims Excellence Manager for review
• Performs other related tasks that may be assigned from time to time
Financial
• Cost Savings from analytics-driven process improvements and fraud detection
• Claims Efficiency: Reduction in manual interventions due to automation or improved data insights
• Audit Cost Reduction: Fewer penalties due to accurate ISO/audit reports
• Support for Strategic Decisions: Financial impact of insights shared with Claims Excellence Manager
Non-Financial
• Report Accuracy & Timeliness: On-time, error free weekly/monthly submissions
• Inquiry Resolution: Fast and complete response to claims data inquiries
• Collaboration Quality: Effective coordination with QA and internal teams
• Audit Readiness: Time and complete ISO/Audit report generation
• Process Improvement: Number of enhancements based on data insights
• Stakeholder Satisfaction: Positive feedback from internal users
MINIMUM QUALIFICATIONS
• Education – Bachelor’s degree in Mathematics, Computer Science, Statistics or any Business-related course
• Experience – Experience in the same field is an advantage
• Technical / functional skills: Above average numerical and verbal skills, with excellent analytical skills, thorough and pay attention to details, with excellent computer skills (e.g. Microsoft Office), knowledge in statistical programming is an advantage
At MediCard, we believe that diversity and inclusion are essential to fostering innovation, collaboration, and growth. We are committed to creating a workplace where everyone, regardless of gender, race, ethnicity, age, sexual orientation, disability, or any other characteristic, feels valued and empowered to contribute their unique perspectives and talents.
Our inclusive hiring practices ensure that we attract, hire, and retain the best talent from all backgrounds. We strive to provide equal opportunities for all candidates and promote a culture of respect, fairness, and transparency. We are dedicated to continuously improving our processes and policies to eliminate biases and barriers, ensuring that every employee has the support and resources they need to thrive.
MediCard is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
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