Claims Examiner | Manila


We’re Hiring.

We are hiring for Customer Service Representatives to join our Healthcare team. Our Customer Service Representatives is an integral role in the operations of our Manila office.

The details.

Day-to-day responsibilities:

  • Analyze, research, and process and/or adjust claims with accurate use of procedures and ICD- 9/10 codes under respective provider and member benefits based on:

– Contractual agreement

– Health Plan division of financial responsibility

– Applicable regulatory legislature

– Claims processing guidelines

– Client group’s and company’s policies and procedures

  • Review and process facility (UB-04) and professional (CMS-1500) claims.
  • Process Medicare member claims based on DMHC and DHS regulatory legislature
  • Respond and resolve providers’ and health plans’ inquires in a timely manner
  • Review services for appropriate charges and apply authorization
  • Monitor aging claims with reports to maintain timeliness
  • Maintain quality and productivity standards
  • Participate in special projects
  • Works closely with Supervisor and reports any issues


Ideal Candidates must have:

  • Bachelor’s degree in related field or AA degree with related experience
  • Must have at least 3 years of applicable healthcare claims adjudication experience within a managed care industry
  • Must be familiar with ICD-9/10, HCPCS, CPT coding, APC, ASC, and DRG pricing.
  • Must be familiar with facility and professional claim billing practices.
  • Must have good written and communication skills.
  • Must be able to follow guidelines, multi-task, and work comfortably within a team-oriented environment.
  • Computer literacy required, including proficient use of Microsoft Word, Excel, Outlook, and EZ-CAP. Crystal Report is a plus.
  • Typing skills of at least 40 wpm.

Salary: ₱30000 - ₱35000
Address: 2/F 1800 Building, Eastwood City, Cyberpark, Bagumbayan, Quezon City Metro Manila