Medical Claim Resolution Expert

2 weeks ago


Manila, National Capital Region, Philippines Viventis Search Asia Full time
Medical Claim Resolution Expert

Viventis Search Asia is seeking a Medical Claim Resolution Expert to help our partner in the BPO industry navigate the complexities of medical claim denials.

About the Role:

  • Claim Denial Resolution: Resolve denied medical claims by preparing and submitting appeals that address specific issues and regulations.
  • Collaboration with Healthcare Teams: Work closely with physicians, nurses, and other medical professionals to gather essential clinical data.
  • Detailed Analysis: Review denial letters to identify root causes and develop strategies for effective appeal submissions.
  • Regulatory Compliance: Ensure all appeals adhere to relevant laws, regulations, and industry guidelines.
  • Progress Monitoring: Track appeal outcomes and ensure timely follow-ups to achieve resolution.

Key Qualifications:

  • Minimum 2 years of experience in clinical appeals writing, with a focus on precision and compliance.
  • At least 1 year of hands-on experience in direct patient care, showcasing expertise in medical terminology and diagnostic procedures.
  • Public Health Registered Nurse (PHRN) certification, ensuring clinical credibility and expertise in medical claims processes.
  • A detail-oriented and analytical mindset, capable of reviewing complex clinical information and crafting compelling appeals.


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