Claims Investigation and Resolution Analyst

3 days ago

Quezon City, National Capital Region, Philippines R1 RCM PHILIPPINES, INC. Full time ₱80,000 - ₱120,000 per year

R1 RCM Philippines, INC. is looking for a Claims Investigation and Resolution Analyst to help resolve issues related to health insurance claims and payments. This role involves working with various teams and insurance companies to ensure claims are processed correctly and on time.

Key Responsibilities:
  • Understand and follow insurance company guidelines using their portals, manuals, and contracts.
  • Submit escalated claims based on specific payer instructions.
  • Review contracts and gather needed documents to help resolve unpaid accounts.
  • Study data to spot trends and ensure compliance with contracts and internal processes.
  • Find the root cause of escalated issues to improve collections and reduce future problems.
  • Work with other departments to solve escalated concerns and avoid repeat issues.
  • Share updates and feedback with clients, teammates, and other departments.
  • Handle moderately complex problems and respond to urgent inquiries.
  • Review payer responses and decide the next steps to resolve issues.
  • Quickly raise concerns to insurance companies or internal teams when needed.
  • Represent issues professionally when dealing with payers, aiming for the best results for our clients.
  • Coordinate with leaders to improve payer performance and resolve escalations efficiently.
  • Support both internal and external customers by managing complaints and escalations.

Qualifications:

  • At least 2 years of experience inhealthcare claims processing or claims analysis, Claims Denials and Appeals, Claims follow-up up or end-to-end Claims within a BPO environment.
  • Knowledge of healthcare claim types and payer requirements is an advantage.
  • Should have 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.
  • Able to work onsite and on rotating shifts.

    With good analytical, problem-solving solving and critical thinking skills.
  • Amenable to work onsite (Quezon City) and on night shift.

Benefits

  • Competitive Total Rewards Package
  • Target variable incentives
  • Medical Plan (HMO) from Day 1 of employment with free dependents
  • Paid Time-Off Benefits

#R1Philippines #AlltogetherBetter #R1JoinTheJourney


Our Recruitment Hub is open to process walk-in applications for our QC and Taguig sites:

QC Address: 18th Floor, Cyberpark Tower 2, Cubao, Quezon City

BGC Address: 11th Floor, Alliance Global Tower, BGC, Taguig City

Schedule: 1 PM to 5 PM

*Please bring 2 valid IDs and a copy of your resume.

Or join our Virtual Hiring via Microsoft Teams

Meeting ID:

Passcode: Rw2zU7aR

Mondays to Fridays - 8 PM-10 PM only. (Except Holidays)


NOTICE: Please be informed that NO candidate seeking a job opportunity with R1 Philippines shall be required to pay any amount as a condition for employment at R1.

R1 does not authorize any third party, agency, company or individual to collect money or request any monetary arrangement in order to receive a job at R1.

If you are contacted by someone asking for payment, please do not respond, and contact us at PH HR - Talent Acquisition  or report to our Ethics Point Hotline, by phone or online access   Philippines: or contact immediately.

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