Medical Claims Examiner

2 weeks ago


Angeles City, Central Luzon, Philippines Your Go to Recruiter Full time
Job Description:

We are seeking a skilled Medical Claims Examiner to join our team at the Sta. Ana Balibago Angeles City Pampanga office.

Key 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, and documentation.

Work Schedule and Salary:
We offer a competitive salary of 16,000 and a work schedule from Monday to Friday, 8:30am-5:30pm. This is an excellent opportunity for someone looking to advance their career in medical claims examination.

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