
Claim Resolution Specialist
1 day ago
The Claim Resolution Specialist plays a versatile role in the claims workflow, tasked with submitting appeals to overturn denials and trigger payments or determining whether further action, such as additional appeals or account closure, is required. Specialists in this role may prioritize tasks based on claim complexity and workload, ensuring optimal productivity while maintaining compliance and accuracy. By efficiently processing high volumes of low-balance claims, the specialist ensures compliance, accuracy, and revenue recovery that supports client success.
Qualifications:
- With at least 1 year solid experience in healthcare claims management, denial resolution, or appeal writing. (NO TO Pharmacy, Dental, Appointment setter)
- Experience in high-volume, low-balance claims processing preferred.
- Familiarity with payer-specific policies, reimbursement methodologies, and contract terms.
- Knowledge of coding principles (e.g., CPT, ICD-10, HCPCS) and medical necessity documentation is a plus.
Job Type: Full-time
Pay: Php30, Php36,500.00 per month
Benefits:
- Health insurance
- Life insurance
- Promotion to permanent employee
Work Location: In person
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