Claims Specialist

Quezon City - Philippines

Monthly Salary: Not Disclosed

Posted on: 2 hours ago

Vacancies: 1 Vacancy

Job Summary

The Claims Specialist manages claim appeals and evaluates next stepswhether submitting additional appeals or closing accounts. They prioritize work based on claim complexity maintain accuracy and compliance and efficiently process high volumes of lowbalance claims to support timely payments and maximize client revenue recovery.

Responsibilities:

Prepare and submit clear well-supported appeals for denied claims using payer rules contracts fee schedules and medical records to secure payment.
Resolve complex denial issues escalated by Claim Status Specialists including coding medical necessity and policy disputes.
Investigate payment discrepancies and take corrective steps to recover underpaid amounts.
Determine whether claims are resolved or need further action such as additional appeals escalation or account closure.
Close accounts when all collection efforts are completed ensuring proper documentation and compliance with client guidelines.
Identify claims that were resolved incorrectly and return them for correction training or further review.
Use documentation from Document Retrieval and Claim Status Specialists to efficiently complete claim resolution tasks.

Minimum Requirements:

At least three years of experience in healthcare claims denial resolution or appeal writing
Proficient in spoken and written English
Experience handling high-volume lowbalance claims is preferred.
Familiarity with payer policies reimbursement methods and contract terms.
Basic knowledge of coding systems (CPT ICD10 HCPCS) and medical necessity documentation is a plus.
Willing to work temporarily at home (25mbps required) and onsite in QC or Pasig
Can start ASAP

Why Apply

Competitive salary
Night differential
Account incentives
Day 1 HMO and Life Insurance
Fully virtual recruitment process

The Claims Specialist manages claim appeals and evaluates next stepswhether submitting additional appeals or closing accounts. They prioritize work based on claim complexity maintain accuracy and compliance and efficiently process high volumes of lowbalance claims to support timely payments and maxi...