Operational 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