US Medical Claims Processor
5 days ago
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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