Claims Resolution Specialist

20 hours ago


Taguig, National Capital Region, Philippines beBeeclaimsresolution Full time ₱800,000 - ₱1,500,000

Job Summary:

Claims Resolution Specialist

We are seeking a skilled Claims Resolution Specialist to join our team. In this role, you will be responsible for identifying and resolving held claim edits, rejections, and denials in accordance with policies, procedures, and regulatory guidelines.

Key Responsibilities:
  • Identify, track, and review revenue cycle held claim edits, rejections, and denials, verifying legal health record documentation to identify appropriate resolution and preventative solutions.
  • Review data quality on diagnosis and procedure codes, addressing National Correct Coding Initiative (NCCI), Outpatient Code Editor (OCE), National Coverage Determination (NCD), and Local Coverage Determination (LCD) edits as necessary.
  • Maintain proficiency in ICD-10-CM, ICD-10-PCS, HCPCS, CPT codes, modifiers, charging, and payment methodologies.
Requirements:
  • 2+ years of direct experience in a hospital setting, healthcare industry, revenue cycle, or coding operations resolving held claims, with a focus on two or more areas such as coding, quality/compliance, documentation integrity, charge validation, revenue integrity, compliance, audit, CDM management/maintenance, and/or denials prevention/management.
  • Proficient in compliant charging and billing practices, state and federal regulations, and AHIMA/AAPC certifications.
Benefits:
  • Group life insurance
  • PTO credits
  • Annual performance bonus
Working Conditions:
  • Amenable to working onsite
  • Willingness to work in a dayshift schedule


  • Taguig, National Capital Region, Philippines beBeeClaim Full time $40,000 - $60,000

    Job Title:Multidisciplinary Medical Claim Resolution SpecialistAbout The Role:We are seeking a detail-oriented and organized Medical Billing Specialist to support our revenue cycle operations in the healthcare industry.Key Responsibilities:Review and manage denied or aging claims through our proprietary billing systemAnalyze claim queues to identify root...


  • Taguig, National Capital Region, Philippines beBeeCustomer Full time ₱35,000

    Claims Resolution SpecialistWe are seeking a highly skilled and detail-oriented professional to join our team in investigating and resolving customer claims related to promotional merchandise.The primary objective of this role is to provide exceptional customer service by managing and investigating incoming customer claims in a timely and professional...


  • Taguig, National Capital Region, Philippines beBeeInsurance Full time ₱2,700,000 - ₱3,900,000

    The role of a Collections Specialist involves handling and resolving insurance follow-up and denial issues to ensure accurate reimbursements from insurance companies.Key Responsibilities:Research and resolve payment discrepancies, collaborating with relevant parties to achieve efficient resolution.Analyze and manage the AR aging report, providing clear...


  • Taguig, National Capital Region, Philippines beBeeClaims Full time ₱35,000

    Investigating and resolving customer claims is a key aspect of this role. You will work with customers to understand their issues, gather relevant information, and determine the appropriate resolution.Key ResponsibilitiesManage incoming customer claims related to promotional product orders, including but not limited to Incorrect or missing imprints, damaged...


  • Taguig, National Capital Region, Philippines beBeeClaim Full time ₱625,500 - ₱751,000

    Medical Biller AR Followup SpecialistClinicMind is looking for a Medical Biller AR Followup Specialist to join their winning team.Job Summary:The ideal candidate will maximize insurance reimbursement for healthcare practice owners by analyzing and resolving claim denials, underpayments, and delays. They will identify root causes of claim issues and propose...

  • Claims Specialist

    6 days ago


    Taguig, National Capital Region, Philippines WHR Global Consulting Full time ₱104,000 - ₱130,878 per year

    Position : Claims Assistant (Non-motor Insurance)Location : Alabang, Muntinlupa CitySetup : OnsiteSchedule : Day ShiftQualifications:Graduate of any 4-year bachelor's degree.2 – 4 years of experience in Non-Motor Claims or prior experience in a claims department or working with insurance claims is a significant advantage.Experience in handling...


  • Taguig, National Capital Region, Philippines beBeeSettlement Full time $7,200 - $7,800

    Claims Resolution SpecialistThis role involves reviewing and validating customer claims, ensuring their accuracy and compliance with established policies and procedures.Key Responsibilities:Review and evaluate customer claims submitted through various channels.Investigate claims to determine validity and eligibility based on company guidelines.Gather and...

  • Claims Specialist

    2 weeks ago


    Taguig, National Capital Region, Philippines beBeeDisability Full time ₱30,000

    Disability Claims Coordinator Job DescriptionWe are seeking a highly skilled Disability Claims Coordinator to join our team.Job Responsibilities:Provide exceptional customer service by answering calls, assisting with policy information, verifying eligibility and claims, and ensuring the satisfaction of each client.Answer inbound/make outbound calls and speak...


  • Taguig, National Capital Region, Philippines beBeeClaimsHandler Full time ₱300,000 - ₱480,000

    As a key member of our team, you will be responsible for handling customer inquiries and providing exceptional service. Your primary objective will be to process claims efficiently and ensure timely resolution.Key ResponsibilitiesClaims Processing: Review, assess, and process routine claims within set timeframes.Customer Communication: Handle customer...

  • Claims Manager

    1 week ago


    Taguig, National Capital Region, Philippines Megaworld Corporation Full time ₱600,000 - ₱1,000,000 per year

    The Claims Manager oversees and facilitates the processing of bond and Contractor's All Risks Insurance (CARI) claims. This involves managing the end-to-end claims process, ensuring timely and accurate submission of required documentation, and actively communicating with insurance companies to expedite claim resolution. The role also requires providing...