Claims Processor
6 months ago
Essential Duties and Responsibilities:
• Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines.
• Verify member eligibility and benefits coverage for submitted claims.
• Evaluate medical documentation to assess the appropriateness of services rendered and coding accuracy.
• Adjudicate claims accurately and efficiently within established turnaround times.
• Identify and investigate potential fraudulent or abusive billing practices.
• Communicate claim decisions, payment details, and denials to providers and members effectively.
• Collaborate with other departments, such as Provider Relations and Customer Service, to resolve claim-related issues and inquiries.
• Maintain comprehensive and organized claim records, documentation.
Qualifications:
• Bachelor’s degree in Healthcare Administration, Business, or related field
• Prior experience in healthcare claims processing or medical billing, preferably within an HMO or managed care organization.
• Proficiency in medical terminology, CPT, HCPCS, and ICD-10 coding principles.
• Familiarity with healthcare reimbursement methodologies, such as DRGs, RBRVS, and fee schedules.
• Strong analytical and problem-solving skills with keen attention to detail.
• Excellent communication skills, both verbal and written, with the ability to interact professionally with internal and external stakeholders.
• Proficiency in using computerized claims processing systems and software applications.
• Ability to prioritize tasks, manage workload efficiently, and meet deadlines in a fast-paced environment
-
Claims Processor
2 months ago
Angeles, Philippines Your Go to Recruiter Full timeCLAIMS PROCESSOR – 1(Sta. Ana Balibago Angeles City Pampanga Office)Work Schedule: Mon-Fri 8:30am-5:30pmSalary Offer: 16, 000Responsibilities: ➢ Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines. ➢ Verify member eligibility and benefits coverage for submitted claims. ➢...
-
Claims Processor
2 months ago
Sta Ana Balibago Angeles, Philippines Your Go to Recruiter Full timeCLAIMS PROCESSOR – 1 (Sta. Ana Balibago Angeles City Pampanga Office) Work Schedule: Mon-Fri 8:30am-5:30pm Salary Offer: 16, 000 Responsibilities: ➢ Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines. ➢ Verify member eligibility and benefits coverage for submitted...
-
Claims Processor
2 months ago
Sta Ana Balibago Angeles, Philippines Your Go to Recruiter Full timeCLAIMS PROCESSOR – 1 (Sta. Ana Balibago Angeles City Pampanga Office) Work Schedule: Mon-Fri 8:30am-5:30pm Salary Offer: 16, 000 Responsibilities: ➢ Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines. ➢ Verify member eligibility and benefits coverage for submitted...
-
Claims Processor
6 months ago
Angeles, Philippines SOURCETECH SOLUTIONS INC. Full timeEssential Duties and Responsibilities: •Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines.•Verify member eligibility and benefits coverage for submitted claims.•Evaluate medical documentation to assess the appropriateness of services rendered and coding...
-
Claims Processor
6 months ago
Angeles City, Philippines SOURCETECH SOLUTIONS INC. Full timeEssential Duties and Responsibilities: • Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines. • Verify member eligibility and benefits coverage for submitted claims. • Evaluate medical documentation to assess the appropriateness of services rendered and coding...
-
Warranty Processor
5 months ago
Marikina City, Philippines MOS-Autosolutions Inc. (Ford Marikina) Full timeThe warranty processor is directly in charge for all warranty concerns and claims of customers. He or she renders decisions regarding these claims based on Ford Motor Company Philippines standards and guidelines. Job Qualifications: -Graduate of Automotive, Engineering or any Business-related course -Preferably male and with driver's license -Computer...
-
Warranty Processor
5 months ago
Marikina City, Philippines MOS-Autosolutions Inc. (Ford Marikina) Full timeThe warranty processor is directly in charge for all warranty concerns and claims of customers. He or she renders decisions regarding these claims based on Ford Motor Company Philippines standards and guidelines. Job Qualifications: -Graduate of Automotive, Engineering or any Business-related course -Preferably male and with driver's license -Computer...
-
PhilHealth Claims Processor
2 weeks ago
Tacloban City, Philippines United Shalom Hospital Full time• Must be a graduate of any 4-year course, preferably in Business Administration, Healthcare Administration, Accounting, or any related field. • At least 1 year of relevant experience in claims processing, benefits administration, or other healthcare-related work. • Previous experience in handling PhilHealth transactions is an advantage. • Proficient...
-
PhilHealth Claims Processor
2 weeks ago
Tacloban City, Philippines United Shalom Hospital Full time• Must be a graduate of any 4-year course, preferably in Business Administration, Healthcare Administration, Accounting, or any related field.• At least 1 year of relevant experience in claims processing, benefits administration, or other healthcare-related work.• Previous experience in handling PhilHealth transactions is an advantage.• Proficient in...
-
PhilHealth Claims Processor
2 weeks ago
Tacloban City, Philippines United Shalom Hospital Full time• Must be a graduate of any 4-year course, preferably in Business Administration, Healthcare Administration, Accounting, or any related field. • At least 1 year of relevant experience in claims processing, benefits administration, or other healthcare-related work. • Previous experience in handling PhilHealth transactions is an advantage. • Proficient...
-
Loans Processor
1 month ago
Quezon City, National Capital Region, Philippines CEPAT KREDIT FINANCING INC. Full timeCPEAT KREDIT FINANCING INC. seeks a skilled and detail-oriented Loans Processor to facilitate the releasing of loan checks and ensure compliance with loan documents and requirements. Key Responsibilities:- Inform clients regarding loan charges, including monthly amortization, deductions, penalties, net proceeds, and documentation requirements before...
-
HR Support Specialist Processor
2 months ago
Taguig City, Philippines J-K Network Services Full timeClient Profile: This company known as IT BPO Company and they aiming to have a positive impact on 10,000 families through their platforms, serving up to 100 companies nationwide within 10 years of their inception. Also their company excels in providing services such as back office support, finance and accounting, HR recruitment and compliance, digital...
-
HR Support Specialist Processor
2 months ago
Taguig City, Philippines J-K Network Services Full timeClient Profile: This company known as IT BPO Company and they aiming to have a positive impact on 10,000 families through their platforms, serving up to 100 companies nationwide within 10 years of their inception. Also their company excels in providing services such as back office support, finance and accounting, HR recruitment and compliance, digital...
-
Loans Processor
8 months ago
Pasig City, Philippines CEPAT KREDIT FINANCING INC. Full timePerforms administrative functions such as facilitate the releasing of loan check and ensuring compliance of the borrower to loan documents or requirements.Key Responsibilities:* Informs the client regarding loan charges such as monthly amortization, deductions, penalties, net proceeds and documentation requirements prior to release of loan.* Ensures that...
-
Loans Processor
6 months ago
Quezon City, Philippines CEPAT KREDIT FINANCING INC. Full timePerforms administrative functions such as facilitate the releasing of loan check and ensuring compliance of the borrower to loan documents or requirements. Key Responsibilities: - Informs the client regarding loan charges such as monthly amortization, deductions, penalties, net proceeds and documentation requirements prior to release of loan. - Ensures...
-
Loans Processor
6 months ago
Quezon City, Philippines CEPAT KREDIT FINANCING INC. Full timePerforms administrative functions such as facilitate the releasing of loan check and ensuring compliance of the borrower to loan documents or requirements. Key Responsibilities: - Informs the client regarding loan charges such as monthly amortization, deductions, penalties, net proceeds and documentation requirements prior to release of loan. - Ensures...
-
Health Clinical Services Associate
1 month ago
Cebu City, Central Visayas, Philippines RecruiterPH Full timeJob DescriptionWorks with a client physician and their care team to complete documentation of clinic visits/encounters. QDS support healthcare providers and their patients by using an artificial intelligence (AI) technology platform to complete confidential medical summaries of patient encounters/visits.The AI technology platform combined with QDS save time...
-
Accounts Payable Specialist
2 months ago
Quezon City, Philippines Comrise Global Solutions Full timeDuty 1: Invoice/Expense Processing Enters approved expense claims / good invoices submitted to the database in Accounting System Performs data validation/ verification to achieve SOP on data consistency Validates and checks purchase order requirements for correctness and applicability (2-way, 3-way, 4-way match) Validate approval, completeness and...
-
Accounts Payable Specialist
2 months ago
Quezon City, Philippines Comrise Global Solutions Full timeDuty 1: Invoice/Expense Processing Enters approved expense claims / good invoices submitted to the database in Accounting System Performs data validation/ verification to achieve SOP on data consistency Validates and checks purchase order requirements for correctness and applicability (2-way, 3-way, 4-way match) Validate approval, completeness and...
-
Accounts Payable Specialist II
2 months ago
Quezon City, Philippines Nityo Infotech Services Philippines Full timeHybrid (8day RTO/month) • Minimum of 3 year of work experience relevant experience Duty 1: Invoice/Expense Processing •Enters approved expense claims / good invoices submitted to the database in Accounting System •Performs data validation/ verification to achieve SOP on data consistency •Validates and checks purchase order requirements for...