Healthcare Claims Specialist

4 days ago

Mandaluyong City, National Capital Region, Philippines ISTA Solutions Full time ₱900,000 - ₱1,200,000 per year

ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Healthcare Customer Service Representative to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly skilled professionals, who prioritize employee satisfaction and work-life balance. At ISTA Solutions, we pride ourselves on creating a culture focused on long-term success and life-long learning. We're looking for a team player who is ready to contribute to our mission, just like you
Account Specific Roles and Responsibilities:

  • Review and process ambulance insurance claims, ensuring accuracy and compliance with client and insurance requirements
  • Work directly with clients to address inquiries, provide updates, and resolve claim-related concerns
  • Verify claim details including eligibility, coverage, and supporting documentation
  • Apply knowledge of medical and diagnosis codes to ensure correct claim submission and adjudication
  • Identify and escalate discrepancies, denials, and appeals as needed
  • Maintain accurate and timely claim records in line with company and client standards
  • Uphold confidentiality and compliance with HIPAA guidelines

Requirements

  • Above average verbal and written English communication skills
  • Healthcare experience is REQUIRED
  • Medical claims and prior authorization experience preferred but not required
  • Knowledge of medical and diagnosis codes is required
  • Strong attention to detail with a focus on accuracy
  • Ability to work independently while managing multiple tasks

Benefits
What Can We Offer You?

  • Competitive salary and benefits
  • Health Insurance with free dependents
  • 10%-night differential
  • Attendance Bonus
  • Paid Time Off
  • Convertible to Cash Leave Credits
  • Performance Appraisal
  • Work-life Balance
  • A focus on growing your career path with us
  • We encourage you to follow your passions and learn new skills

Our Commitment To You

  • Strong culture and values-driven leadership
  • We create opportunities for you to learn and grow at any stage of your career
  • Continuous learning and innovation
  • We foster an all-inclusive environment where everyone thrives

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