Healthcare Claims Processor

21 hours ago


Pasig, National Capital Region, Philippines Manpower Core Group Inc. Full time
Company Overview

Manpower Core Group Inc. is a leading staffing solutions provider dedicated to connecting talented professionals with top employers across various industries. Our mission is to deliver exceptional service, ensuring seamless matches between job seekers and clients alike.

Job Responsibilities

* Provide comprehensive support to the clinical team and client team, ensuring efficient workflow and effective communication.
* Review contractual language and medical documentation to determine customer eligibility, guaranteeing accurate and timely decisions.
* Assess the medical appropriateness of claims submitted, adjusting them as needed to maintain fairness and accuracy.
* Process all covered claims accurately and promptly, adhering to industry standards for decision turnaround times.

Requirements

* A valid active license is required for this position.
* Applicants must have at least 6 months of Hospital experience to be considered for this role.
* Prior authorization experience of at least 1 year, with negotiable healthcare experience, is also a requirement.
* Effective handling of payer side, provider side, scheduling, or any inbound process is crucial for success in this position.
* Strong typing skills are necessary for efficient claim processing.

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