Ready to make an impact? At Hive Health and HPPI, a subsidiary of 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!
About the Role
As the Claims Benefit Manager, you will lead Hive’s medical adjudication operations to ensure claims are reviewed accurately, efficiently, and in alignment with policies and regulatory standards. You’ll oversee a team of medical liaisons responsible for evaluating claims, managing provider coordination, and maintaining quality and compliance across the process.
This is both a strategic and hands-on leadership role. You’ll drive continuous process improvements, coordinate across departments such as Adjudication, Legal, and Provider Partnerships, and play a key part in shaping how Hive delivers fast, fair, and reliable claims experiences to its members and providers.
Responsibilities
Lead and manage the medical liaisons team to meet accuracy, quality, and service targets
Oversee daily adjudication operations to ensure claims are processed efficiently and in compliance with policy guidelines
Conduct audits to ensure claims accuracy, completeness, and consistency with internal standards
Identify potential cases of fraud, waste, or abuse (FWA) and coordinate investigations with Legal and Compliance
Work cross-functionally with Claims, Provider Partnerships and Healthcare Services to address recurring operational issues
Monitor key metrics such as turnaround time, quality scores, and error rates, and implement corrective measures as needed
Drive continuous process improvements to enhance provider and member experience in the claims process
Qualifications
Bachelor’s degree in nursing, healthcare management, business, or a related field
At least 5 years of experience in operations, healthcare administration, or team management
Strong analytical and problem-solving skills, with a focus on process improvement
Experience leading teams and driving performance in fast-paced environments
Comfortable working with data, reports, and digital systems to track metrics and quality outcomes
Excellent communication and stakeholder management skills across both medical and non-medical teams
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.
What We Do
Hive Health is on a mission to provide hassle-free HMO for small-medium enterprises (SMEs) and startups in the Philippines.
We offer comprehensive, hassle-free HMO plans through our all-in-one platform. Founded at Harvard and Stanford and backed by top global investors such as Y Combinator, this award-winning startup is revolutionizing access to quality, affordable healthcare for millions of Filipinos, one SME at a time.
