Senior Claims Processing Executive

1 day ago

Iloilo City, Western Visayas, Philippines Infojini Inc Full time ₱45,000 - ₱72,000 per year

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

Key Responsibilities

  • Contact end patients, employers, and attorney representatives in the U.S. to gather essential information for completing complex medical claims.
  • Serve as the primary liaison between clients and responsible parties, ensuring smooth communication and follow-through.
  • Review, analyze, and evaluate complex claims using the client's proprietary software, systems, and tools.
  • Use payer documentation to determine reimbursement status and perform accurate, timely data entry.
  • Conduct thorough telephone follow-ups with payers and responsible parties to confirm receipt of claims and expedite reimbursements.
  • Prepare initial bill packets and appeal letters using the client's systems, ensuring all required supporting documents are compiled and submitted correctly to insurance companies.
  • Assist in gathering additional documentation and assembling complete billing packets to support insurance claim submission.
  • Maintain, organize, and handle confidential documents and Patient Health Information (PHI) in strict adherence to HIPAA guidelines.
  • Consistently meet or exceed monthly Quality Audit and Production standard targets set by the client.
  • Collaborate effectively with TES team members to enhance overall team performance and efficiency.
  • Identify and escalate process improvement opportunities to support operational optimization.
  • Perform additional duties as assigned to support business operations and client requirements.

Required Skills

  • Bachelor's Degree in any discipline.
    •
  • 2+ years experience in BPO US Healthcare Account in Voice process.
  • Competent in MS Office Suite and Windows applications.
    • Strong verbal communication skills.

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