Claims Analyst
16 hours ago
Claims Analyst – Professional Billing (PB) The Claims Analyst – Professional Billing (PB) is responsible for analyzing, auditing, and resolving claims related to professional (physician and ancillary) services to ensure accurate billing, coding, and reimbursement. This position plays a key role in supporting the revenue cycle by reviewing claim accuracy, identifying trends or discrepancies, and ensuring compliance with payer contracts, coding guidelines, and regulatory standards. Key Responsibilities Review and analyze professional billing claims for accuracy, completeness, and compliance with payer policies and coding standards (CPT, HCPCS, ICD-10). Identify, research, and resolve claim rejections, denials, and underpayments through detailed root‑cause analysis. Perform claim audits to ensure billing integrity and adherence to payer contracts and CMS regulations. Partner with coding and billing teams to correct claim errors and submit timely appeals or resubmissions. Monitor claim trends, payment variances, and denial rates; provide actionable insights and recommendations for process improvements. Interpret payer fee schedules, EOBs, and remittance advices to validate payment accuracy. Support configuration and maintenance of claim processing rules in billing systems (e.g., Epic PB, Cerner, or other practice management systems). Prepare reports and dashboards tracking key performance metrics, such as clean claim rates, denial rates, and reimbursement accuracy. Collaborate cross‑functionally with revenue integrity, compliance, and finance to ensure alignment of billing practices with internal policies and external regulations. Stay current on industry changes, including payer updates, coding revisions, and regulatory requirements (e.g., CMS, HIPAA, OIG). Qualifications Education & Experience Bachelor’s degree in healthcare administration, business, finance, or related field preferred. 2+ years of experience in professional billing, claims analysis, or healthcare revenue cycle management required. Strong understanding of CPT, HCPCS, ICD-10 coding, and payer billing requirements. Experience with billing and EHR systems (e.g., Epic Professional Billing, Cerner, Athena, or equivalent) strongly preferred. Familiarity with payer contracts, remittance processing, and reimbursement methodologies (FFS, capitation, value‑based). Excellent analytical and problem‑solving skills with strong attention to detail. Proficient in Microsoft Excel and data analysis/reporting tools; experience with SQL or BI tools is a plus. Strong understanding of healthcare billing workflows, payer rules, and compliance standards. Effective written and verbal communication skills with ability to collaborate across departments. Ability to manage multiple tasks and meet deadlines in a fast‑paced environment. Key Performance Indicators (KPIs) Denial and rework rate Average days to resolve claim issues Payment variance accuracy Timeliness and accuracy of audits and reports Seniority level Associate Employment type Full‑time Job function Finance and Analyst Referrals increase your chances of interviewing at Health Business Solutions by 2x. Get notified about new Claims Analyst jobs in Metro Cebu . Location Cebu, Central Visayas, Philippines #J-18808-Ljbffr
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Claims Analyst
3 weeks ago
, , Philippines DOXA Talent Full timeOur client is seeking a Claims Analyst, who will support their risk management and legal functions. This position is responsible for collecting and processing claims-related data, preparing reports, and assisting in the development and analysis of risk management practices. In addition, this role will also handle documentation, assist on projects and provide...
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Claims Account Analyst
3 weeks ago
, , Philippines Asurion Full timeOverview Claims Account Analyst is responsible for evaluating claims to ensure they are accurate and processed in a timely manner. They review and assess the validity of claims based on the policy guidelines. They also follow precise procedures in managing high-volume claims according to department goals and deadlines. Responsibilities Evaluate all claims...
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Claims Analyst II
4 weeks ago
, Central Luzon, Philippines AIG Full timeClaims Analyst II At AIG, we’re reinventing the way we help clients manage risk. Join us as Complex Claims Analyst II to play your part in that transformation. This is an opportunity to develop your skills and experience as an important member of the Claims Auto team. How You’ll Make an Impact Analyze auto complex claims, adjust reserves, issue payments...
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Medical Claims Analyst
3 weeks ago
, , Philippines Med-Metrix, LLC Full timeJob Description Join our dynamic team and make a meaningful impact in the healthcare industry. As a Medical Claims Analyst, you'll play a pivotal role in ensuring accurate claims processing while advancing your career in a supportive and innovative environment. Enjoy competitive benefits upon hire, ongoing professional development, and the satisfaction of...
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Claims Analyst I
19 hours ago
, Central Luzon, Philippines AIG Full timeOverview Claims Analyst I Who we are? American International Group, Inc. (AIG) is a leading global insurance organization. AIG member companies provide a wide range of property casualty insurance in approximately 70 countries and jurisdictions. These diverse offerings include products and services that help businesses and individuals protect their assets and...
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Accounts Receivable Claims Clerk
3 days ago
Philippines Remote VA Full time ₱250,000 - ₱500,000 per yearA claims analyst is responsible for reviewing and evaluating claims submitted by customers, ensuring their accuracy, eligibility, and compliance with company policies, by investigating claims, determining validity, and customer settlement (credit) amounts while maintaining detailed records and communicating with team lead for approval.RequirementsReview and...
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Rebates Claim Analyst
3 days ago
Cebu Philippines R&D Lexmark Full time ₱1,200,000 - ₱2,400,000 per yearResponsibilities :Analyzes and reviews claims for accuracy, completeness and eligibility. Ensures timely payment of rebates based on established Service Level Agreement. Prepares and maintains reports for account monitoring purposes. Partner management on issue resolutions. Helps identify and resolves pain points to continuously improve customer...
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Actuarial Analyst
3 weeks ago
, , Philippines ECLARO Full time3 weeks ago Be among the first 25 applicants Get AI-powered advice on this job and more exclusive features. Direct message the job poster from ECLARO 5-6 years' experience, P&C background is preferred. Heavy data input and analysis. Responsibilities Aggregate and stack loss runs from various file types. Interpret and analyze large volumes of data (mostly...
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FNOL Analyst
4 weeks ago
, Central Luzon, Philippines AIG Full timeFNOL Analyst Who we are? American International Group, Inc. (AIG) is a leading global insurance organization. AIG member companies provide a wide range of property casualty insurance in approximately 70 countries and jurisdictions. These diverse offerings include products and services that help businesses and individuals protect their assets and manage...
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Reserving Analyst
4 weeks ago
, , Philippines ECLARO Full timeReserving Analyst will provide reserving support to a variety of insurance and reinsurance lines written out of Bermuda. This position will be integral in carrying out the reserving process and in building out the analysis and tools needed for robust reserve estimation. The position will report to the Head of Reserving, Bermuda. Responsibilities &...
