Medical Claims Processor

4 hours ago

Pasay, National Capital Region, Philippines Access Healthcare Full time ₱420,000 - ₱480,000 per year

Job description:

We are looking for Claims Analyst to be part of our PIONEER TEAM

You'll be responsible for managing the entire claims process from initiation to resolution, ensuring accuracy, compliance, and efficiency.

This role involves analyzing and processing healthcare claims, identifying discrepancies, and working closely with internal teams and clients to resolve issues and maintain service excellence.

Work scope :

  • End-to-End Claims Processing: Manage the full lifecycle of healthcare claims, including claims intake, adjudication, follow-up, and final payment or denial.
  • Claims Review & Analysis: Review submitted claims to ensure accuracy, completeness, and compliance with healthcare policies and regulations.
  • Eligibility Verification: Verify patient eligibility and benefits in real-time to ensure correct claim processing.
  • Claim Discrepancy Resolution: Investigate and resolve claim discrepancies or rejections, collaborating with providers, payers, and internal teams to resolve issues.
  • Documentation & Reporting: Maintain thorough documentation of claims activities, issues, resolutions, and follow-up actions.
  • Customer Support: Assist in addressing customer inquiries and provide status updates on claims in progress.
  • Compliance: Ensure all claims adhere to industry standards, regulations, and payer-specific requirements (HIPAA, CMS, etc.).
  • Collaboration: Work cross-functionally with other departments (e.g., billing, coding, customer service) to ensure timely and accurate claims processing.
  • Continuous Improvement: Contribute to process improvements, providing feedback to enhance the efficiency and effectiveness of claims operations.

Qualifications:

  • At least 1 year of experience in healthcare claims processing or claims analysis, Claims Denials and Appeals, Claims follow up or End to end Claims within a BPO environment.
  • Strong knowledge of healthcare claim types, coding systems (CPT, ICD-10, HCPCS), and payer requirements.
  • Familiarity with healthcare industry standards (HIPAA, CMS, etc.).
  • Experience with claims management software and electronic claim submission platforms.
  • Excellent written and verbal communication skills.
  • Ability to work independently and within a team in a fast-paced environment.

Job Type: Full-time

Pay: Php35, Php40,000.00 per month

Benefits:

  • Additional leave
  • Health insurance
  • Life insurance
  • Opportunities for promotion
  • Paid training
  • Pay raise
  • Promotion to permanent employee
  • Transportation service provided

Ability to commute/relocate:

  • Pasay: Reliably commute or planning to relocate before starting work (Required)

Experience:

  • Medical Claims: 1 year (Required)
  • Claims Denials and Appeals: 1 year (Required)
  • Healthcare Customer Service Representative: 1 year (Required)
  • End to end Claims: 1 year (Required)

Work Location: In person

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