Senior BPM Associate
2 days ago
Role Description
Responsible for the accurate processing and completion of medical claims based defined claims guidelines and policies. Associate can demonstrate proficiency in product lines applicable to the processing unit.
- Process new claims or modifies existing claims according to the appropriate and applicable action
- Analyze claims to determine appropriate action to approve or deny a claim for payment
- Determine accurate payment criteria for clearing pending claims based on defined policies and procedures
- Research claims edits to determine appropriate benefit application utilizing established criteria, applies physician contract pricing as needed for entry-level claims
- Review and address provider inquiries regarding claim adjudication
- Demonstrate ability to work on high volume of repetitive claims
- Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards
Work Experience
- At least 2 years experience in medical claims
- Experience with medical coding to include diagnosis coding and terminology is an advantage but not required
Skillset
- Proficient knowledge on US Healthcare Practice, Medical Coding (ICD-10, CPT4, DRG, HCPCS), Clinical Documentation Improvement, medical terminologies, EDI, and HIPAA protocols is a must
- Ability to multi-task and follow documented claims processes with minimal supervision
- Excellent verbal and written business communication skills required
- Strong proficiency in Windows OS and Microsoft Office applications, particularly Excel
- Strong attention to detail and the ability to make appropriate decisions based on information presented
Skills
Claims,HIPAA,US Healthcare,Windows OS and Microsoft Office
-
Senior BPM Associate
15 hours ago
Taguig, National Capital Region, Philippines UST Full timeRole DescriptionReporting to the Customer Service Manager, the Customer Service Associate will provide exceptional customer service to the UST customers via inbound Call Center Operations.Duties/ResponsibilitiesReceive and respond to inbound phone calls for customer assistanceRespond to outbound phone call requestsDocument all calls in ticketing and tracking...
-
Senior BPM Associate
6 days ago
Taguig, National Capital Region, Philippines UST USource Full timeUST HealthProof is seeking a Healthcare Utilization Management Intake Analyst. In this role, you will be responsible for supporting the coordination of medical services, including utilization management intake, requesting medical records, and handling provider requests to ensure the effective use of healthcare services. You will play a vital role in...
-
Senior BPM Associate
6 days ago
Taguig, National Capital Region, Philippines UST Full timeRole DescriptionUST HealthProof is seeking a Healthcare Utilization Management Intake Analyst. In this role, you will be responsible for supporting the coordination of medical services, including utilization management intake, requesting medical records, and handling provider requests to ensure the effective use of healthcare services. You will play a vital...
-
Senior BPM Associate
2 days ago
Taguig, National Capital Region, Philippines UST Full timeRole DescriptionUST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members' well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve...
-
Senior BPM Associate
14 hours ago
Taguig, National Capital Region, Philippines UST Full timeRole DescriptionRespond to customer inquiries via telephone and written correspondence, providing accurate and comprehensive information about insurance benefits, claims, and provider contractsAnalyze customer issues and deliver effective solutions promptly and professionally Retrieve and document customer information, activities, and changes accurately...
-
Associate BPM Lead
6 days ago
Taguig, National Capital Region, Philippines UST USource Full timeUST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS (Business Process as a Service) solutions manage complex administrative tasks, empowering our customers to focus on prioritizing the well-being of their members. Guided by our commitment to simplicity, honesty, and leadership, we...
-
Associate BPM Lead
6 days ago
Taguig, National Capital Region, Philippines UST Full timeRole DescriptionUST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS (Business Process as a Service) solutions manage complex administrative tasks, empowering our customers to focus on prioritizing the well-being of their members. Guided by our commitment to simplicity, honesty, and...
-
Customer Support Senior Associate
2 days ago
Taguig, National Capital Region, Philippines SYSGEN RPO Full timeURGENT MULTIPLE HIRING NEEDSWork Schedule: Rotating Shift / FlexibleWork Location: Taguig, 2X onsite + WFH (may shift to full onsite)Customer Support Senior Associate (DV360)2–5 years' experience in email, call, and chat supportStrong campaign management background; heavy on technical troubleshootingBasic scripting: HTML, CSS, JavaScriptDigital Marketing...
-
Associate BPM Lead
16 hours ago
Taguig, National Capital Region, Philippines UST Full time6 OpeningsTaguig CityRole descriptionResponsible for the accurate processing and completion of medical claims based on defined guidelines and policies.Process new claims or modifies existing claims according to the appropriate and applicable actionAnalyze claims to determine appropriate action to approve or deny a claim for paymentDetermines accurate payment...
-
IT Audit Senior Associate
4 days ago
Taguig, National Capital Region, Philippines Risewave Consulting, Inc. Full timeIT Audit Senior AssociateWe are looking for a highly skilledIT Audit Senior Associateto join our team. This role involves evaluating IT-related controls, identifying risks, and ensuring compliance with regulatory and organizational standards. The ideal candidate is detail-oriented, analytical, and capable of working in a dynamic environment.Key...