Claims Resolution Specialist

2 days ago

Iloilo City, Western Visayas, Philippines Kavi Global Full time

As part of the Tech Enabled Services (TES) Team of Kavi Philippines, the Claims Resolution Specialist contacts patients, employees, attorney representatives, and other responsible parties to gather information related to collecting payments for complex claims. The Claims Resolution Specialist acts as the liaison between key Client contacts and end patients/employers/attorneys primarily through phone.

Responsibilities:

  • Contact end patients and their employers and attorney representatives in the US to gather information to complete the claim.

  • Analyze and evaluate complex claims payments using end Client's proprietary software, systemsand tools.

  • Use payment documentation provided by payers to determine if the medical provider has been reimbursed and perform accurate and timely data entry.

  • Conduct timely and thorough telephone follow-up with payers and other responsible parties to ensure claims with supporting documentation have been received and facilitate prompt reimbursement.

  • Prepare correct complex claim initial bill packet or appeal letter using the end Client's systems tools andsubmit with all necessary supporting documentation to insurance companies.

  • Assist in obtaining supporting claim documentation, appropriately compiling billing packets, and filing insurance claims.

  • File and handle confidential documentation and Patient Health Information (PHI); able to adhere and follow all Health Insurance Portability and Accountability Act (HIPAA) mandated guidelines to safeguard data privacy and medical information.
  • Meet or exceed Client's monthly Quality Audit metric and Production standard targets consistently.
  • Collaborate well with other TES team members to improve team efficiency.
  • Assist with operational research by highlighting process areas of improvement.
  • Other duties as required.

Education:

  • Diploma / Bachelor's Degree in any discipline, or 3+ years of work experience in US HC BPO

Experience:

  • Experience working for a US based BPO OR US healthcare insurance industry experience OR a similar experience recommended
  • Competent in MS Office Suite and Windows applications

Skills and Prerequisites:

  • Pass English Online Tool Assessment – oral and written –
  • Strong verbal communication skills in English.
  • Fast and accurate typing skills while maintaining a conversation.
  • Multitasking of data entry while conversing with Client contacts and insurance companies and other responsible parties..
  • Ability to professionally and confidently communicate to outside parties via phone, email and fax.
  • Ability to handle large volumes of work while maintaining attention to detail.
  • Ability to work in a fast-paced environment.
  • Work under limited supervision, manage multiple tasks and prioritize assignments within limited time constraints.
  • Effectively communicate issues/problems and results that impact timelines for project completion.
  • Ability to interact professionally at multiple levels within the organization.
  • Timely and regular attendance.

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