US Medical Claims Processor

5 days ago

Pasig, National Capital Region, Philippines Visaya Knowledge Process Outsourcing Corporation Full time $40,000 - $60,000 per year

Role: US Medical Claims Specialist - ACTIVE POOLING

About Visaya KPO:

Visaya Knowledge Process Outsourcing Corporation is a proudly Filipino organization recognized globally for service excellence, innovation, and a culture of malasakit. We are committed to building long-term partnerships through quality, reliability, and a people-first approach.

Role Overview:

We are looking for a detail-oriented US Medical Claims Processor/Specialist to join our team. The ideal candidate will have hands-on experience in processing and adjudicating medical claims within the US healthcare system, with strong knowledge of claims systems—specifically Trizetto's QNXT. This role requires accuracy, efficiency, and a solid understanding of claims workflows, coding, and compliance standards.

Key Responsibilities:

  • Review and process medical claims in Trizetto's QNXT for accuracy and compliance.
  • Validate eligibility, benefits, authorizations, and coding (CPT, ICD-10, HCPCS).
  • Investigate and resolve claim discrepancies, denials, and appeals.
  • Communicate with providers, payers, and internal teams to clarify issues.
  • Maintain accurate documentation of claims activities and resolutions.
  • Ensure compliance with HIPAA, company policies, and regulatory requirements.
  • Support audits, quality checks, and process improvements.

Qualifications:

  • College level education required; bachelor's degree preferred.
  • Minimum of 2 years' experience in US medical claims processing/claims adjudication.
  • Hands-on experience with Trizetto's QNXT platform is required.
  • Familiarity with CPT, ICD-10, and HCPCS coding systems.
  • Strong knowledge of US healthcare claims workflows, payer policies, and medical billing standards.
  • Excellent analytical, communication, and problem-solving skills.
  • Ability to work efficiently with high attention to detail and accuracy.
  • Willingness to work onsite in Ortigas on a night shift schedule.

Perks and Benefits:

  • 15% Night Differential
  • HMO coverage after 30 days of employment (with option to add up to 2 dependents)
  • Retirement Benefits
  • 24 Leave Credits per year (convertible to cash)
  • Wholistic Employee Wellness Program

Why Join Visaya KPO?

  • Be part of a multi-awarded, 100% Filipino-owned company recognized for its leadership and innovation in the outsourcing industry1.
  • Work in a culture that values professional growth, employee well-being, and long-term partnerships.
  • Enjoy industry-leading benefits and a supportive, inclusive environment.

Visaya KPO is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

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