Medical Claim Specialist

24 hours ago


Quezon City, National Capital Region, Philippines beBeeClaim Full time $40,000 - $60,000
Job Title:

Medical Claim Analyst

About the Position:

A highly skilled Medical Claim Analyst is sought after to maximize insurance reimbursement for healthcare practice owners by identifying opportunities for improvement in claims processing and follow-up.

Key Responsibilities:
  • Maximize insurance reimbursement by analyzing medical insurance claim denials, underpayments, or delays to determine root causes and propose effective resolutions.
  • Interact with US-based insurance carriers to follow up on unpaid claims, delayed processing, and underpayment, ensuring timely resolution and optimal reimbursement.
  • Develop and execute medical insurance claim denial appeal processes, resulting in increased revenue for healthcare practices.
  • Collaborate with US-based practice owners and clinicians to complete and correct any missing or incorrect data on their insurance claims, ensuring accurate billing and maximum reimbursement.
Required Skills and Qualifications:
  • A minimum of 6 months experience in US-based AR follow-up and charge and payment posting.
  • A college degree in Computer Engineering, Mathematics, or a similar field.
  • Hands-on experience with data analysis and classification, as well as good analytical skills.
  • Familiarity with the US medical insurance industry and insurance claims processing cycle.
  • Knowledge of ICD-10, CPT, and HCPC coding systems.
  • Understanding of CMS-1500 and UB-04 claim formats.
  • Excellent listening, communication, and problem-solving skills.
  • Self-motivated and able to work autonomously.
  • Experience working with chiropractic, physical therapy, and mental/behavioral health specialties.
Preferred Skills:
  • High comfort level working on Eastern Time Zone/US Shift.
  • Good internet access at home.
  • Mobile Hotspot.
  • Laptop/Desktop of at least 8 GB.


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