Medical Adjudication Specialist

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. If you thrive in a fast-paced, innovative environment and want to work on solutions that truly matter, we’d love to meet you!

👋🏻 Hi! We’re HPPI, part of the Hive Health Group

About Us

HPPI is an HMO that is part of the Hive Health Group of Companies, which is on a mission to provide the best-in-class health plans for small-medium enterprises (SMEs) in the Philippines.

HPPI’s 30+ years of providing care, combined with Hive Health’s innovative tech capabilities, enables the Hive Health Group of Companies to offer comprehensive, hassle-free digital health plans through our all-in-one platform. Together, we are revolutionizing access to quality, affordable healthcare for millions of Filipinos, one SME at a time.

About The Role

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

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

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

Qualifications

• 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.

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