Medical Adjudication Specialist

Pasig Office - HybridHybridfull-timemid

Other

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Quick Summary

Overview

Ready to make an impact? At Hive Health, 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.

Key Responsibilities

As an Medical Adjudication Specialist, your areas of responsibilities include: Provide clinical guidance to ambiguous, complex outpatient cases to facilitate approvals of medical availments.

Requirements Summary

At least 3 years of relevant clinical experience, with familiarity on health coverage policies and a graduate of medical school Creative, detail-oriented, proactive in problem solving and identifying opportunities Curious, results-driven, ownership…

Technical Tools

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About the Role

~1 min read

As an Medical Adjudication Specialist, you will play a key role in optimizing healthcare operations by meticulously reviewing, analyzing, and validating medical availments and claims, ensuring accuracy, compliance, and timely resolution to support seamless service delivery.

As a member of the team, you will work closely with the other functions and innovations in continuously delivering user experience improvements and introducing best-in-class strategies and processes that will help Hive Health provide an unparalleled healthcare experience for Filipinos.

This is a hybrid role based in Ortigas, Pasig.

Responsibilities

~1 min read

As an Medical Adjudication Specialist, your areas of responsibilities include:

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Provide clinical guidance to ambiguous, complex outpatient cases to facilitate approvals of medical availments.
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Review, adjudicate, and approve cases related to inpatient discharges, ensuring accurate coverage decisions and smooth patient transitions.
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Take the lead in providing critical weekend and after-hours support, ensuring urgent cases are managed promptly and healthcare services remain uninterrupted.
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Evaluate member utilization by analyzing claims data, categorizing cases by illness, and determining remaining coverage limits to ensure proper benefit allocation.

Requirements

~1 min read

At least 3 years of relevant clinical experience, with familiarity on health coverage policies and a graduate of medical school
Creative, detail-oriented, proactive in problem solving and identifying opportunities
Curious, results-driven, ownership mentality with growth mindset
Excellent verbal and written communications
Collaborative team player with the ability to adapt quickly in a fast-paced environment
Passion for innovation in healthcare

Join 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.
🚀 Grow with us – mentorship, career development, and learning opportunities to help you thrive.
🌍 Global connections – gain insights and support from top minds at Harvard, Stanford, and beyond.