Claims Examiner | Manila
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.
- 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