About this role
<p><strong>Location:</strong> Meycauayan, Bulacan, PH<br><strong>Company:</strong> Nestlé Integrated Business Services Manila, Inc.<br><strong>Job Type:</strong> Full Time<br><strong>Education:</strong> Bachelor’s Degree (Medical-related course preferred)<br><strong>Experience:</strong> At least 2+ years of experience in medical, healthcare, or BPO environment</p> <p> </p> <p>Joining <strong>Nestlé </strong>means being part of the largest food and beverage company in the world, driven by a purpose to enhance quality of life and contribute to a healthier future.</p> <p> </p> <p><strong>Nestlé Integrated Business Services Manila, Inc.</strong> delivers world-class business support across global markets, with a strong focus on accuracy, efficiency, and service excellence. </p> <p> </p> <p>As a <strong>Medical Risk Specialist</strong>, you will support the delivery of medical insurance and risk management services across markets. You will play a critical role in <strong>medical claims processing, insurance analysis, and stakeholder coordination</strong>, ensuring accuracy, compliance, and timely resolution of insurance-related activities.</p> <p> </p> <p>You will collaborate closely with <strong>Group Risk Services (GRS), Total Rewards, and external insurance providers</strong> to drive operational excellence and continuous improvements in medical insurance processes.</p> <p> </p> <h2><strong>A Day in the Life</strong></h2> <p> </p> <ul> <li>Analyze <strong>medical claims, billing, and coding data</strong> to ensure accuracy and completeness of insurance processes</li> <li>Manage and process <strong>medical insurance claims</strong>, including validation, documentation, and follow-ups with insurers</li> <li>Coordinate with internal stakeholders and external partners (insurers, brokers, third-party administrators) to resolve issues and escalations</li> <li>Maintain and validate <strong>employee census data</strong> aligned with insurance policies and agreements</li> <li>Prepare reports on <strong>claims utilization, trends, and risk insights</strong> to support decision-making</li> <li>Support <strong>governance, compliance, and internal control activities</strong> in relation to medical insurance</li> <li>Drive <strong>process improvements and automation initiatives</strong> to enhance efficiency and service delivery</li> <li>Conduct regular reviews, stakeholder discussions, and knowledge-sharing sessions</li> </ul> <h2> </h2> <h2><strong>Key Responsibilities</strong></h2> <p> </p> <ul> <li>Ensure <strong>accurate and timely claims processing and reporting</strong></li> <li>Manage and resolve <strong>insurance-related queries and escalations</strong></li> <li>Maintain high-quality <strong>medical data management standards</strong></li> <li>Support <strong>risk analysis, compliance, and governance frameworks</strong></li> <li>Deliver insights through <strong>data analysis and reporting</strong></li> <li>Contribute to <strong>continuous improvement and stakeholder satisfaction</strong></li> </ul> <h2> </h2> <h2><strong>Qualifications & Skills</strong></h2> <p> </p> <ul> <li>Bachelor’s degree in <strong>Nursing, Medical Technology, Psychology, or related field</strong></li> <li>Minimum of <strong>2 years’ experience</strong> in healthcare, medical insurance, or BPO setting</li> <li>Knowledge of <strong>medical insurance processes, claims handling, and coding</strong></li> <li>Proficiency in <strong>MS Office (Excel, Word)</strong> and familiarity with <strong>SAP systems</strong></li> <li>Experience in <strong>data analysis, reporting, and database management</strong></li> <li>Understanding of <strong>risk management, compliance, and internal controls</strong></li> </ul>