Claims Resolutions Specialist

2 weeks ago

Ortigas Metro Manila, Philippines Connext Global Solutions Inc Full time ₱30,000 - ₱60,000 per year

Job Summary

The Claims Resolution Specialist is responsible for following up on health insurance claims and resolving denied claims through thorough investigation and problem-solving. This role ensures timely reimbursement by addressing root causes of denials and working with insurance companies to secure payments.

Responsibilities


• Spends 6-8 hours of day making claims calls.

• Spends hold times basic-statusing claims using provider portals.

• Conducts claim follow-up/denial resolution every 2 weeks minimum per claim.

• Determines if medical records are necessary and submits requests to the Compliance and Records Department.

• Determines if a Claim Submission Request is required to resolve a claim denial.

• Ensures complete accuracy of information gathered.

• Exhausts all options before requesting an appeal from the assigned onshore agent to be written and mailed in.

• Follows up on and documents appeal statuses.

• Communicates actions that need to be taken to process claims to assigned onshore agent.

• Documents claim payments issued by check, EFT, or VCC on CollaborateMD and Jira.

• Communicates department needs to assigned onshore agent.

• Maintains up-to-date knowledge of insurance payer requirements.

Qualifications and Requirements


• Strong analytical skills to determine the validity of refund claims and draft appeals effectively.

• Ability to Identify and resolve issues related to refund requests and claim reimbursements in a timely manner.

• Clear and coherent in both written and verbal communication skills to effectively conduct discussions to resolve refund issues and appeals.

• Continuously seeks ways to improve the accuracy and efficiency of refund processing.

• Exhibits sound and accurate judgment in evaluating refund claims and making decisions on whether to approve, deny, or appeal refund requests based on careful consideration of available information.

• Strong time management skills to handle multiple requests and develop realistic action plans to ensure timely and accurate resolution of refund issues.

• Observes safety and security procedures related to handling sensitive payment information to maintain data integrity and confidentiality.

Screening Criteria


• High school diploma or an equivalent combination of education and related work experience.

• At least two (2) years of experience in in claims processing or a similar role in the healthcare or insurance industry.

• Must have a stable employment history.

  • Claims Resolutions Specialist | PHP 5,000 Sign-On Bonus | On-Site

    4 weeks ago

    , Metro Manila, Philippines Connext Global Solutions Inc Full time

    Connext is a dedicated team of business process outsourcing experts and innovators, with experience in supporting world-class companies in Title and Escrow, Healthcare, Produce Distribution, Retail and Fashion, Design Consulting, and Finance. We are currently looking for a Claims Resolutions Specialist who will be working with Connext's Client in the United...

  • Customer Card Customer Service Specialist

    2 weeks ago

    Ortigas, Metro Manila, Philippines Prime Technology Specialist Incorporated Full time ₱200,000 - ₱250,000 per year

    Customer Service Specialist (LuvIt Customer Card)Industry: Lending / Banking / Financial ServicesLocation: Ortigas Pasig Employment Type: Full-time Onsite / Mon to FridayJob Summary:We are looking for a Customer Service Specialist to handle inquiries and concerns related to the LuvIt Customer Card. The role focuses on providing high-quality assistance to...

  • Dayshift, Claims/Insurance Specialist

    2 weeks ago

    Ortigas, Philippines People Matter PH Full time ₱468,000 - ₱636,000 per year

    Primary Responsibilities:Handle insurance-related tasks and work independently across multiple client platforms.Improve operational efficiency by identifying issues, creating streamlined processes, and ensuring regulatory compliance.Deliver excellent customer service through effective communication, understanding client needs, and fostering strong client...

  • US Medical Claims

    2 weeks ago

    Ortigas, Philippines Comrise Full time ₱360,000 - ₱396,000 per year

    Job PurposeThe representative is responsible for collections, account follow up, billing and allowance posting for the accounts assigned to them.Duties and ResponsibilitiesFollow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.Meets and maintains daily productivity/quality standards established in...

  • Claims Representative

    4 weeks ago

    , Metro Manila, Philippines Eastvantage Business Solutions Inc. Full time

    Eastvantage is urgently hiring Customer Support Specialists for our Healthcare – Claims Processing Account . If you're passionate about helping others, detail-oriented, and ready to thrive in a dynamic environment, we want you on our team! What You'll Do: Handle inbound and outbound calls related to healthcare claims Assist members and providers with claim...

  • CSR Healthcare Account

    2 weeks ago

    Ortigas Pasig, Philippines Eastvantage Full time

    About the role Eastvantage Business Solutions Inc. is looking for a full-time Customer Service Representative to join our thriving healthcare account team. In this dynamic role, you will be responsible for handling claims and billing inquiries, providing excellent customer service to our clients and their patients. What you'll be doing Respond to inbound...

  • Healthcare Accounts Receivable Specialist

    2 weeks ago

    Ortigas, Metro Manila, Philippines MED-METRIX INTERNATIONAL PH-I, INC. Full time ₱250,000 - ₱500,000 per year

    Join our dynamic team and make a meaningful impact in the healthcare industry. You'll play a pivotal role in ensuring accurate claims processing while advancing your career in a supportive and innovative environment. Enjoy competitive benefits upon hire, ongoing professional development, and the satisfaction of helping others every day. Take the next step in...

  • AR Specialist

    2 weeks ago

    Ortigas, Metro Manila, Philippines Eastvantage Business Solutions Inc. Full time ₱28,000 - ₱33,000 per year

    Application Reminder: Please apply only if you meet and accept the following requirements:At least 2 years of experience as a Customer Service Representative (handling phone calls, emails, and ticket requests), specifically supporting medical/healthcare collections accounts—responsible for identifying claims and denials, and coordinating with providers to...

  • Claims Analyst

    4 weeks ago

    Manila, Philippines Manulife Full time

    Claims Analyst Position Responsibilities Create death benefit packages and send correspondence via fax, mail, or email to obtain missing documents. Report any overpayments, underpayments, and other financial irregularities related to claims. Process high-priority claims transactions, including settlements, policy closures, asset freezing, and notifying...

  • Customer Support Specialist

    1 week ago

    Ortigas, Metro Manila, Philippines Eastvantage Business Solutions Inc. Full time ₱25,000 - ₱33,000 per year

    Application Reminder: Please apply only if you meet and accept the following requirements:Willing to work in an on-site setup in St. Francis Square, Ortigas, Pasig City.Comfortable with night shift aligned with US Time (9:00 PM – 6:00 AM Manila Time)Accepts a fixed salary range of Php 25,000 to Php 33,000, depending on experience (this range is...