Claims Specialist

Overview Are you an expert in resolving denied claims and improving reimbursement rates? As a Claims Denial Management Specialist , you will play a crucial role in ensuring accurate claims processing, analyzing denials, and implementing solutions to reduce revenue loss. Join our dynamic team and make a real impact on financial performance Responsibilities Follow-Up with Insurance Carriers via all mediums to determine reason for claims denial and work to resolve medical claims for payment. Research problem accounts to ensure accuracy. Ability to resolve insurance denials and file appeals with government and commercial carriers. Analyze the unpaid medical claims and denials and identify/investigate the reasons for nonpayment and which action is needed to resolve timely. Adheres to applicable policies, hospital/physician billing/departmental practices and 3rd party requirements. Denial Management—analyzing and resolving denied claims. Investigate the reasons for denials, identify errors or discrepancies, and take corrective actions, such as submitting appeals. Review and analyze denied claims, identify patterns, and take corrective action. Work closely with insurance providers to dispute denials and secure claim approvals. Identify root causes, collaborate with billing teams, and implement strategies to minimize rejections. Maintain up-to-date knowledge of insurance policies, coding regulations (CPT, ICD-10), and payer requirements. Use claim management software and reporting tools to track denials, appeals, and financial impact. Experience: 2+ years in claims denial management, medical billing, or healthcare revenue cycle. Knowledge: Strong understanding of insurance policies, claim processing, and medical coding (CPT, ICD-10, HCPCS). Skills: Excellent analytical, problem-solving, and negotiation skills to handle claim disputes effectively. Tech Savvy: Proficiency in medical billing software. Attention to Detail: Strong organizational skills with the ability to manage multiple denials and appeals efficiently. Benefits and Additional Details Competitive Compensation package with Salary Appraisals Saturday-Sunday Off Equipped with the latest technologies Monthly Incentive Rewards on successful orders and Attendance Productivity Offers Full-time employment and Career Growth Easily accessible from almost any part of the Metro Cebu area. One-day Application Process only Service Incentive Leaves Upon Regularization Attendance Productivity Incentives Additional Hazard Pay within Qualifying Hours Stable Job with Salary Appraisals Holiday and Night Differential Premium Pay Rates Job Promotion is highly possible... if YOU have the drive. HMO/Health Insurance Work-Life Balance Free Pre-hiring Medical Laboratories Free Coffee Staff Outsourcing Solutions, is an offshoring and outsourcing solutions provider based in Cebu. We enable foreign businesses to reduce costs, increase flexibility, and extend their global output by providing the most efficient ways we deliver our services. Our unique approach with dedication and commitment effectively removes the stress and conflict that would normally exist in businesses that are consistently keeping up with today\'s global demands. Staff Outsourcing Solutions firmly believes in being transparent to its clients to apply effective ways to deliver results that extend your global reach. The variety of services we offer that targets specific market segments makes us a reliable and long-term solid partner to our clients. The opportunities we provide enabled us to serve several business organizations ranging from small start-ups to mid-size multinationals. With the core competencies of our professional workforce with excellent proficiency in English and flexible services, Staff Outsourcing Solutions is the right partner as an offshore and BPO solutions provider. Overview Staff Outsourcing Solutions specializes in hosting, setting up, and managing offshore business operations in the Philippines on behalf of our clients from all over the world. Through offshoring business processes, our clients drastically reduce operational costs, increase flexibility, expand the reach on their operations globally, meet the increasing demand, and provide quality solutions around the world. The unique services we cater to our client\'s needs adapt to their specific needs. Staff Outsourcing Solutions has been flexible in offering services to different foreign business organizations, from small and medium-sized businesses to large multinational corporations. #J-18808-Ljbffr