Deskripsi Pekerjaan
Virtual Staffing Solutions OPC is seeking a dedicated and results-driven Payment Integrity Supervisor to join our team in Cebu City. In this pivotal role, you will lead efforts to maximize cost-saving strategies within a Third-Party Administrator (TPA) or insurance carrier environment.
As a key member of our operations team, you will be responsible for overseeing the detection, investigation, and recovery of incorrectly paid claims. Your expertise will directly impact our organization's financial health by implementing robust controls, conducting thorough audits, and identifying opportunities to eliminate waste and fraud in the payment process.
This is an on-site position that offers career growth potential in the dynamic insurance and superannuation sector. You will work closely with cross-functional teams to develop and refine payment integrity protocols, mentor junior staff, and ensure compliance with industry regulations and company policies.
If you are passionate about driving operational efficiency, reducing financial losses, and making a meaningful contribution to a growing organization, we encourage you to apply and become part of our committed team.
Tanggung Jawab
- Lead and supervise daily payment integrity operations to ensure accurate claim processing and cost recovery
- Develop and implement strategies to identify, prevent, and recover incorrectly paid claims in TPA or insurance settings
- Conduct comprehensive audits of claims data to detect patterns of fraud, waste, and abuse
- Collaborate with claims adjusters, underwriters, and other stakeholders to resolve payment discrepancies
- Mentor and train junior team members on payment integrity best practices and procedures
- Prepare detailed reports on cost-saving achievements, recovery rates, and operational metrics for management review
- Ensure compliance with regulatory requirements, company policies, and industry standards
- Identify and recommend process improvements to enhance efficiency and reduce financial losses
Kualifikasi
- Bachelor's degree in Insurance, Finance, Accounting, Business Administration, or a related field
- Minimum of 3-5 years of experience in payment integrity, claims auditing, or insurance operations
- Strong knowledge of TPA processes, insurance claim workflows, and reimbursement methodologies
- Proven experience in fraud detection, cost containment, or recovery operations
- Excellent analytical skills with the ability to interpret complex data and draw actionable insights
- Strong leadership and team management capabilities
- Detail-oriented mindset with a commitment to accuracy and compliance
- Proficiency in MS Office applications and experience with claims management systems is preferred