Medical Claims Specialist

13 hours ago


Bacoor, Calabarzon, Philippines beBeeInsurance Full time ₱500,000 - ₱800,000

We are seeking a Medical Claims Specialist to join our team. As a key member of our organization, you will be responsible for maximizing insurance reimbursement, identifying root causes for claim denial, and interacting with US-based insurance carriers.

About the Role
  1. Maximize insurance reimbursement for healthcare practice owners by ensuring accurate and timely submission of claims.
  2. Identify root causes for medical insurance claim denial, underpayment, or delay and propose resolutions to minimize financial losses.
  3. Interact with US-based insurance carriers to follow-up on unpaid claims, delayed processing, and underpayment.
  4. Develop and execute medical insurance claim denial appeal processes to ensure fair resolution.
  5. Collaborate with US-based practice owners and clinicians to complete and correct any missing or incorrect data on their insurance claims.
Requirements
  1. Minimum 6 months experience in US-based AR follow-up and charge and payment posting.
  2. College degree in Computer Engineering, Mathematics, or similar field.
  3. Hands-on experience with data analysis and data classification.
  4. Good analytical skills and ability to identify patterns and trends.
  5. Familiarity with US medical insurance industry and insurance claims processing cycle.
  6. Knowledge of ICD-10, CPT, and HCPC coding systems.
  7. Understanding of CMS-1500 and UB-04 claim formats.
  8. Experience with Vericle Software is an advantage.
  9. Excellent listening, communication, and problem-solving skills.
  10. Self-motivated and able to work autonomously.
  11. Experience with chiropractic, physical therapy, and mental/behavioral health specialties.
Preferred Skills
  1. High comfort level working on Eastern Time Zone/US Shift.
  2. Good internet access at home.
  3. Mobile Hotspot.
  4. Laptop/Desktop of at least 8 GB.


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