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Medical Claims Specialist

1 month ago

Davao City, Davao, Philippines Connext Global Solutions Inc Full time

Connext Global Solutions is a dedicated team of business process outsourcing experts and innovators, with experience in supporting world-class companies in Title and Escrow, Healthcare, Produce Distribution, Retail and Fashion, Design Consulting, and Finance.

We are currently looking for a Medical Claims Specialist who will be working with Connext's Client in the United States of America.

What's in it for you?

  • Competitive compensation

  • Perfect Attendance Bonus

  • Life insurance

  • HMO Insurance

  • Great company culture

  • Annual Merit Increase

  • 25% Night Differential

What is the job?

The Medical Claims Specialist is responsible for managing and processing insurance claims to ensure accuracy, compliance with insurance policies, and timely reimbursement.

Responsibilities:

  • Organize data and submit claims for assigned contracts.

  • Verify hours and review group notes for accuracy.

  • Complete daily/monthly audits to ensure all billable days are accounted for and submitted.

  • Ensure all policies are billed with monthly SharePoint VOB checks.

  • Communicate necessary actions for submitting claims.

  • Report missing/short hours to Charge Specialists and audit before facility submission.

Qualifications:

  • At least one (1) to two (2) years of experience in medical billing or insurance claims processing.

  • Strong understanding of insurance payer requirements and policies for compliance.

  • Proficient in maintaining organized records of claims, communications, and documentation.

  • Skilled in using Microsoft Office Suite for document management and collaboration.

  • Experienced in using Collaborate MD for submitting, tracking, and managing insurance claims.

  • Detail-oriented in data entry and review to ensure accuracy and completeness.

  • Effective communicator, both written and verbal, in addressing claims-related issues with stakeholders.

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