Medical Claims Representative

2 weeks ago

Taguig, National Capital Region, Philippines bde75dff-3139-4d16-a431-77eacc569fbc Full time ₱360,000 per year

Job Summary

The Healthcare Accounts Receivable (A/R) Specialist is responsible for the timely and accurate resolution of outstanding insurance account balances through payment collection, adjustment, or write-offs. This role ensures the integrity of billing processes and supports the overall revenue cycle through proactive follow-up and problem resolution.

This job description will be reviewed periodically and is subject to change based on management discretion.

Responsibilities

  • Perform A/R follow-up on assigned accounts, ensuring adherence to payer-specific timely filing limits.
  • Submit adjustment or write-off requests for approval to resolve outstanding balances.
  • Prepare and submit medical record packets for reprocessing, reconsideration, or appeals.
  • Receive inbound calls and call backs from insurance payers regarding active accounts.
  • Resolve claim rejections and ensure clean claim submission to the payer.
  • Respond to email inquiries from internal departments regarding pending insurance balances or claim denials.
  • Maintain accurate, detailed notes and documentation within applicable systems.
  • Notify the Supervisor and/or Manager of any system issues or workflow barriers.
  • Follow all legal and ethical guidelines for protecting patient and company confidentiality (HIPAA).
  • Perform other duties as assigned.

Basic Qualifications | Education

  • Completed at least 2 years of college; Associate or Bachelor's Degree preferred.
  • Excellent oral and written communication skills.
  • Strong understanding of U.S. healthcare insurance claims and billing processes.

Preferred Qualifications

  • Proficiency in Medicare and strong general payer knowledge.
  • Ability to read and interpret Explanation of Benefits (EOBs).
  • Basic skills in Excel, Word, and Outlook.
  • Proficiency in typing using keyboards, 10-key pads, and calculators.
  • Strong computer/software skills.
  • Detail-oriented with strong analytical ability.
  • Typing speed of at least 35 WPM.
  • Willingness to work occasional weekends as needed.
  • Flexibility to work night shift hours (between 6:00 PM to 10:00 AM Philippine Standard Time).
  • Amenable to working overtime or rest day shifts when business needs require additional paid hours.

Competencies

  • Internal Candidates: At least 1 year of tenure in ACH.
  • External Candidates: Minimum of 1 year experience in healthcare insurance collections and/or correspondence management.

Job Type: Full-time

Pay: Up to Php30,000.00 per month

Benefits:

  • Company events
  • Health insurance
  • Opportunities for promotion
  • Paid training
  • Promotion to permanent employee

Application Question(s):

  • Healthcare Insurance Collections
  • Please provide your Viber number for faster communication.

Location:

  • Taguig (Required)

Work Location: In person

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