Medical Claims Analyst

3 hours ago


Pasig, National Capital Region, Philippines John Clements Consultants, Inc. Full time ₱1,200,000 - ₱1,800,000 per year

Job Purpose

  • Follow-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 departmental policies.
  • Uses the workflow system, client host system and other tools available to them to collect payments and resolve accounts.
  • Adheres to the policies and procedures established for the client/team.
  • Knowledge of timely filing deadlines for each designated payer.
  • Performs research regarding payer specific billing guidelines as needed.
  • Ability to analyze, identify and resolve issues causing payer payment delays.
  • Ability to analyze, identify and trend claims issues to proactively reduce denials.
  • Communicates to management any issues and/or trends identified.
  • Initiate appeals when necessary.
  • Ability to identify and correct medical billing errors.
  • Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process.
  • Understanding of under or over payments and credit balance processes.
  • Assist with special A/R projects as needed. Analytical skills and the ability to communicate
  • results are required.
  • Act cooperatively and courteously with patients, visitors, co-workers, management and clients.
  • Use, protect and disclose patients' protected health information (PHI) only in accordance with
  • Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Work independently from assigned work queues.
  • Maintain confidentiality at all times.
  • Maintain a professional attitude.
  • Other duties as assigned by the management team

Qualifications

  • Completed at least High School education
  • With minimum 1 year of Healthcare Account Receivable/Collections in a BPO setting or environment (claims payments processing, claims status and tracking, Medical Billing, AR
  • Follow ups, Denials and Appeals-outbound healthcare providers)
  • Experienced on medical billing/ AR Collections.
  • Background in calling insurance (Payer) to verify claim status and payment dispute.
  • Must be amenable to work night shifts


  • Pasig, National Capital Region, Philippines HCM Nexus Full time $40,000 - $60,000 per year

    Job DescriptionWe are looking for a Medical Claims Analyst (AR) to join our growing US Healthcare team. This role involves handling both inbound and outbound calls (30% outbound) to ensure accurate and timely resolution of accounts receivable and medical claims. You'll collaborate with healthcare providers and insurance representatives to process claims...


  • Pasig, National Capital Region, Philippines Comrise Full time ₱1,800,000 - ₱3,600,000 per year

    We are looking for a Medical Claims Analyst – AR to join our team. This role involves handling U.S. healthcare provider billing, managing accounts receivable collections, and completing various claims-related tasks. The ideal candidate has strong analytical skills, solid knowledge of medical billing processes, and excellent communication abilities. You...


  • Pasig, National Capital Region, Philippines Connext Full time ₱400,000 - ₱800,000 per year

    Job SummaryThe Medical Claims Specialist is responsible for the timely submission of technical or professional medical claims to insurance companies. This role involves verifying patient and billing information, editing claims for compliance, resolving denials, and communicating with both payers and internal teams.Responsibilities• Utilize various...


  • Pasig, National Capital Region, Philippines Connext Global Solutions Inc Full time ₱40,000 - ₱80,000 per year

    Job SummaryThe Medical Claims Specialist is responsible for the timely submission of technical or professional medical claims to insurance companies. This role involves verifying patient and billing information, editing claims for compliance, resolving denials, and communicating with both payers and internal teams.Responsibilities• Utilize various...


  • Pasig, National Capital Region, Philippines Health Business Solutions Full time ₱2,500 - ₱4,000 per year

    Key ResponsibilitiesReview denied medical claims to determine reasons for denial (coding errors, missing information, medical necessity, eligibility, etc.).Collect, organize, and verify supporting documentation needed for appeals or audits.Prepare and submit claim audit packets for internal review or external payor reconsideration.Collaborate with clinical...

  • medical records

    6 hours ago


    Pasig, National Capital Region, Philippines Prime Hospital and Medical Center Pasig Full time ₱250,000 - ₱500,000 per year

    Duties and Responsibilities:A. Records ManagementMaintain and update patient medical records and hemodialysis treatment logs.Ensure completeness, accuracy, and confidentiality of all patient information.File and retrieve patient charts and records efficiently.Encode and track dialysis treatment sessions and laboratory results in the hospital system.B. ICD-10...


  • Pasig, National Capital Region, Philippines Fortune General Insurance Corporation Full time ₱252,000 - ₱264,000 per year

    A. JOB SUMMARYThe Non-Motor Claims Analyst reports to the Claims Officer and Assistant Manager, Non-Motor Claims and is responsible for end-to-end processing of designated Personal Accident (PA) Claims and other related tasks as assigned. This includes validating documents, evaluating Claims, coordinating with the assureds and/or intermediaries, and ensuring...


  • Pasig, National Capital Region, Philippines Connext Full time ₱150,000 - ₱250,000 per year

    Connext Global Solutionsis 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 MedicaClaims Resolution Specialistwho will be working with Connext's...


  • Pasig, National Capital Region, Philippines Fortune General Insurance Corporation Full time ₱200,000 - ₱500,000 per year

    The Claims Assistant reports to the Claims Officer and Assistant Manager, Non-Motor Claims and is responsible for end-to-end processing of designated Personal Accident (PA) Claims and other related tasks as assigned. This includes validating documents, evaluating Claims, coordinating with the assureds and/or intermediaries, and ensuring timely and accurate...


  • Pasig, National Capital Region, Philippines Fortune General Insurance Corporation Full time $80,000 - $150,000 per year

    A.      JOB SUMMARYThe Claims Assistant reports to the Claims Officer and Assistant Manager, Non-Motor Claims and is responsible for end-to-end processing of designated Personal Accident (PA) Claims and other related tasks as assigned. This includes validating documents, evaluating Claims, coordinating with the assureds and/or intermediaries, and...