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Claims Examiner | Manila

Description:

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



Requirements:

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