Medical Claims Analyst

JOB PURPOSE:Responsible for analyzing, adjudicating, auditing, and processing claims (In-Patient, Out-Patient Hospital Bills and Professional Fees) according to set medical guidelines, and policies within the agreed SLAs (Service Level of Agreements)JOB QUALIFICATIONS:Graduate of Bachelor of Science in Nursing or any related medical course - FRESH GRADUATES...

JOB PURPOSE:Responsible for analyzing, adjudicating, auditing and processing of claims (Member's Reimbursement) according to set medical guidelines, policies within the agreed SLAs (Service Level of Agreements).Principal Accountability:Ensures accurate and timely processing of claims from medical service providers within authority limits. This...

We're Hiring: Provider Dispute Claims Processor We are seeking an experienced Provider Dispute Claims Processor this role is responsible for reviewing, researching, adjudicating medical claims and resolving provider disputes in compliance with regulatory guidelines and internal policies. This role requires strong analytical skills, a high level of accuracy,...

Qualifications:A graduate of Doctor of Medicine.Minimum 3-5 years of medical practice experience required.Valid PRC medical license required for this position.Knowledge of complex disease conditions, treatments, tests, and medications.With high attention to details and strong analytical skills.Excellent oral and written communication skills.Ability to...

The Claims Analyst is responsible for the overall review, assessment, and decision of claims.Position Responsibilities: Determine eligible benefits based on documents submitted and policy provisions.Adjudicate claims and determine corresponding recommendation or decision within prescribed approval limits and within the defined turnaround time.Ensure accurate...

Your Role:"We are in the business of paying claims"-  your role is to help us uphold this promise.Job Summary:The Claims Adjudicator for Medical Facilities is responsible for evaluating and processing claims from hospitals, laboratories, and clinics. This role ensures accredited facility partners receive their service payments based on approved limits....

We're looking for a Claims Analyst to join our Insurance Operations team at MBPS. In this role, you are responsible for the overall review, assessment, and decision on payment for claims.Position Responsibilities: Responsible for the complete assessment, calculation and final decision on claims (ex. Group life, AD&D, Survivor Income claims, TDMI, Personal...

Job Objective / PurposeThe Claim Processor is responsible for timely processing of medical claims based on the member's health benefit program. They analyze medical information, perform data entry, handle reimbursement claims, and decide whether a claim should be covered or denied. Communicate issues or exceptions to other concerned departments as...

 Acknowledge receipt of Claim requests. Upload claim documents to case in the health claims system Validate claim details in the health claims system Update Claim status and notes in the health claims system Update TPA file for endorsement to Claims Control Team Adheres to service standards of processing administrative requests Ensures...

 Acknowledge receipt of Claim requests. Upload claim documents to case in the health claims system Validate claim details in the health claims system Update Claim status and notes in the health claims system Update TPA file for endorsement to Claims Control Team Adheres to service standards of processing administrative requests Ensures...