Medical Claims Specialist

17 hours ago


San Fernando, Central Luzon, Philippines beBeeClaims Full time ₱25,000 - ₱40,000

Job Title: Medical Claims Specialist

Job Description:

A medical claims specialist is responsible for accurately and efficiently processing medical claims, ensuring timely payments to healthcare providers.

  • Verify patient information and ensure correct insurance filing details.
  • Review and process claims using billing software, including electronic and paper claim processing.
  • Follow up on unpaid claims within the standard billing cycle time frame.
  • Research and appeal denied claims in compliance with HIPAA regulations.
Key Responsibilities:
  • Handle sensitive patient information with confidentiality and integrity.
  • Check eligibility and benefit verification for accurate payment processing.
  • Review patient bills for accuracy and completeness, ensuring no errors or discrepancies.
  • Stay updated on insurance guidelines, including HMO/PPO, Medicare, and state Medicaid regulations.
Additional Skills:
  • Eligibility verification and precertification through web or verbal communication with insurance companies.
  • Credentialing knowledge an added advantage.
  • Denial management knowledge.


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