Abstract

This study assessed the effectiveness of the Claims Management Section office services at World Citi Medical Center in relation to outpatient satisfaction. Despite the hospital’s long-standing reputation for quality care, gaps were observed in outpatient claims processing, particularly in communication, turnaround time, and coordination with external insurers. This research aimed to evaluate the current service quality and identify areas requiring improvement to enhance outpatient satisfaction. The study employed a quantitative descriptive research design. Data were gathered from 30 outpatient respondents who had processed insurance claims through the hospital’s Claims Management. A structured questionnaire was used to gather data and statistical tools such as frequency distribution, percentage, and weighted mean were applied to analyze the data. Most respondents were young adult women, college educated, and primarily processed PhilHealth claims. The office received high service-quality ratings across five dimensions: communication and clarity, timeliness and efficiency, accuracy and reliability, coordination and collaboration, and use of digital tools. The overall weighted mean indicated strong agreement regarding service effectiveness. Outpatient satisfaction also received high ratings across six dimensions, with an overall mean of 3.77, reflecting strongly positive experiences with claims-processing services. The study concludes that while the hospital demonstrates strong internal claims management performance, patient satisfaction is influenced by factors beyond its direct control, especially insurer processing schedules. Strengthening partnerships with insurance providers, implementing real-time claim tracking systems, and enhancing communication are recommended. These measures could further improve efficiency and sustain high outpatient satisfaction levels.