Claim Assistant
2 weeks ago
Location: Onsite – Cabancalan, Mandaue City, Cebu
Schedule: Monday to Friday | Shifting schedule (mostly 8:00 PM – 5:00 AM)
Employment Type: Full-time
About the Role
We are looking for a highly organized and detail-oriented Claims Specialist to join our healthcare operations team. This role ensures that all insurance claims are submitted accurately, on time, and in compliance with each insurer's requirements. The ideal candidate is proactive, analytical, and able to work under pressure in a fast-paced environment while collaborating with clinical and administrative teams.
Key Responsibilities
Claims Preparation & Submission
Process and submit claims to all affiliated insurance partners promptly and accurately after each service or event.
- Review claim information to ensure data accuracy, complete documentation, and compliance with insurance requirements.
- Verify that the provider is credentialed and in-network prior to claim submission to avoid denials or payment delays.
Eligibility Verification & Documentation Management
Check and validate patient eligibility and benefits prior to the date of service.
- Ensure that all necessary supporting documents—including Dental Notes, X-rays, treatment plans, and patient forms—are collected and properly uploaded to the system.
- Monitor real-time document completion during the event day to guarantee smooth claim processing.
Follow-Up & Patient Coordination
Contact patients with pending cash payments or balances and coordinate collection or payment follow-up.
- Address inquiries related to billing, coverage, or claim status with professionalism and clarity.
- Communicate with providers or internal teams regarding missing or incomplete information needed for claim completion.
Data Management & Reporting
Maintain detailed and updated records of all submitted, pending, and paid claims in company databases.
- Prepare summary reports and update dashboards for management review.
- Track claim performance, reimbursement timelines, and patterns of denials to support process improvements.
Team Collaboration & Process Improvement
Work closely with the clinical, finance, and operations teams to ensure claims accuracy and timely submission.
- Support process improvement initiatives to optimize claim turnaround and reduce rejections.
- Demonstrate flexibility to work across time zones and adjust to event-based schedules when needed.
Qualifications
- Bachelor's degree in any field (preferably in Business, Healthcare, or related disciplines).
- At least 1–2 years of experience in claims processing, insurance billing, or healthcare administration.
- Strong attention to detail with the ability to manage multiple priorities effectively.
- Excellent written and verbal communication skills.
- Proficiency in Microsoft Office, Google Workspace, and familiarity with CRM or claims management systems.
- Ability to work under pressure, meet deadlines, and collaborate effectively within a team.
Why Join Us
- Be part of an international healthcare organization with a growing presence in the U.S., U.K., and Philippines.
- Enjoy a supportive and dynamic work environment where your contributions truly matter.
- Opportunities for learning, growth, and advancement in healthcare operations.
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