Medical Claims Associate

2 weeks ago


Alabang, Philippines WHR Global Consulting Full time

Work Set-Up: ONSITE Work Schedule: Nightshift schedule Work Location: Onsite – Alabang Corporate Center Salary: Php: 30,000 + 15% Night Diff + HMO Day 1 and 1 free dependent Qualifications - Bachelor’s Degree in any field. - At least 2 years of experience in a Healthcare BPO environment. - Proven experience handling inbound calls within a healthcare account. - Familiarity with medical claims, eligibility verification, and denial management processes. - Strong command of medical terminology. - Excellent verbal and written communication skills. - Strong interpersonal and customer service skills. - Ability to work independently with minimal supervision. - High level of accuracy, attention to detail, and organizational skills. - Proficient in Microsoft Office and other computer application systems. Job Summary * We are looking for experienced and detail-oriented Medical Claims Associates to join our growing contact center team in Alabang. * The ideal candidates will have a strong background in healthcare BPO operations, particularly in handling inbound calls related to medical claims, eligibility verification, and claim status updates. * You will serve as a key liaison between patients, providers, and insurance companies, ensuring accurate, efficient, and customer-focused service delivery. Key Responsibilities - Handle inbound calls from patients, providers, and insurance representatives regarding medical claims, eligibility, and benefits. - Review, interpret, and explain claim denials and status updates in a clear and professional manner. - Accurately document all call interactions and actions taken in the system. - Ensure compliance with HIPAA and other healthcare privacy standards. - Collaborate with internal teams to resolve claim discrepancies or process issues. - Maintain a high level of accuracy and attention to detail in all transactions. - Meet or exceed daily, weekly, and monthly performance targets. - Continuously update knowledge of medical terminology, insurance policies, and claim processing protocols.


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