Medical Risk Specialist

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