Medical Adjudication Specialist

As a Medical Adjudication Specialist at HPPI, your core responsibilities will include reviewing, analyzing, and validating medical claims to ensure accuracy in coverage decisions. You'll provide clinical guidance on complex outpatient cases and play a pivotal role in managing inpatient discharge cases, ensuring a smooth experience for patients. Additionally, you will analyze claims data to evaluate member utilization and ensure proper benefit allocation. Your contributions will directly support HPPI's goal of delivering exceptional healthcare solutions.

To be considered for the Medical Adjudication Specialist position at HPPI, candidates should possess at least three years of relevant clinical experience and must be a graduate of medical school. Familiarity with health coverage policies is essential, as well as excellent communication skills, a detail-oriented mindset, and a proactive approach to problem-solving. HPPI values collaborative team players who can adapt quickly to a fast-paced and innovative healthcare environment.

HPPI is dedicated to the growth of its Medical Adjudication Specialists by providing mentorship, career development opportunities, and various learning resources. The company promotes a culture of continual improvement and encourages team members to embrace innovation in healthcare practices, helping them stay updated with industry trends and enhancing their professional skills.

At HPPI, Medical Adjudication Specialists can expect a dynamic and innovative work environment that promotes collaboration and creativity. While this is primarily a remote role based in Metro Manila, occasional visits to the Ortigas office are required for teamwork and training. This flexible setup allows for a balance between independent work and team engagement, providing an atmosphere where you can thrive and make a difference in healthcare.

Joining HPPI as a Medical Adjudication Specialist comes with a comprehensive range of benefits. Day one coverage for healthcare is offered for you and your dependents, along with paid time off to ensure work-life balance. HPPI prioritizes employee well-being and supports your career progression with countless opportunities for development and learning, all aimed at fostering a rewarding experience as part of their team.

In your response, express your passion for improving healthcare access. Highlight how HPPI's mission aligns with your personal values and professional goals, and mention specific aspects of the company's approach that resonate with you, like their commitment to innovation and quality service.

Provide detailed examples of your past experiences in adjudicating medical cases. Discuss the methodologies you’ve used to ensure accuracy and compliance, and explain how your clinical background informs your decision-making process in reviewing claims.

Discuss your problem-solving skills and share a specific instance where you successfully navigated a complex case. Explain your analytical process and how you collaborate with others to establish clarity and reach effective resolutions.

Emphasize your time management skills and organizational strategies. Discuss the tools or techniques you use to prioritize tasks, ensure timely responses, and maintain attention to detail while juggling various responsibilities.

Outline your understanding of health coverage policies and procedures. Share how you stay informed about policy changes, and describe a situation where you ensured compliance while reviewing claims.

Provide an example of teamwork in action. Describe your role, how you communicated with team members, and the outcome of the collaboration. Highlight the importance of cooperation and how it contributes to effective healthcare delivery.

Discuss specific software or platforms you've used in your previous roles. Emphasize your ability to quickly adapt to new systems and your experience in utilizing technology to streamline the adjudication process for improved efficiency.

Mention your commitment to lifelong learning and staying updated with industry advancements. Discuss any relevant certifications or courses you’ve taken, and how they have enhanced your skills as a Medical Adjudication Specialist.

Share your perspective on current challenges, such as the increasing complexity of claims processing or the need for improved patient communication. Discuss how these challenges can be addressed and your role in contributing to effective solutions.

Articulate your view on the importance of innovation in enhancing healthcare services. Discuss examples of recent advancements that have improved patient outcomes, and relate it back to HPPI's mission and your enthusiasm for being a part of that journey.