Sr. Claims Associates
UST
Date: 1 day ago
City: Taguig
Contract type: Full time
Role Description
Responsible for the accurate processing and completion of medical claims based on defined claims guidelines and policies.
Medical Claims, US Healthcare, Communication, Clinical Documentation
Responsible for the accurate processing and completion of medical claims based on defined claims guidelines and policies.
- Process new claims or modifies existing claims according to the appropriate and applicable action
- Analyze claims to determine appropriate action to approve or deny a claim for payment
- Determine accurate payment criteria for clearing pending claims based on defined policies and procedures
- Research claims edits to determine appropriate benefit application utilizing established criteria, applies physician contract pricing as needed for entry-level claims
- Reviewing and addressing provider inquiries regarding claim adjudication, and other Claims matters
- Assist and/or communicate with providers to fully understand issues and complexities of claims cases
- Demonstrate ability to work on high volume of repetitive claims
- Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards
- Ready to work on a fast-paced learning process and highly engaged to complete all claims cases assigned
- Bachelor’s Degree holder preferably in the field of Nursing, Healthcare and Allied Medical Profession
- Minimum of 2 years of experience in medical claims processing experience
- Knowledge in medical coding, diagnosis coding and terminologies are an advantage but not required
- Proficient knowledge on US Healthcare Practice, Medical Coding (ICD-10, CPT4, DRG, HCPCS), Clinical Documentation Improvement, medical terminologies, EDI, and HIPAA protocols are a must
- Ability to multi-task and follow documented claims processes with minimal supervision
- Excellent verbal and written business communication skills
- Proficiency in Windows OS and Microsoft Office applications, particularly in Excel
- Strong attention to detail and the ability to make appropriate decisions based on information presented
- Amenable to working onsite and 6 months contract
Medical Claims, US Healthcare, Communication, Clinical Documentation
How to apply
To apply for this job you need to authorize on our website. If you don't have an account yet, please register.
Post a resumeSimilar jobs
IT Business Analyst
WHR Global Consulting,
Taguig
3 hours ago
QualicationsBachelor’s degree in Business Administration, Information Technology, Computer Science, or a related field.Minimum of 2 to 3 years relevant work experience.Strong analytical and problem-solving skills.Excellent communication and interpersonal skills.Familiarity with Agile or other project management methodologies.Highly Motivated and deadline drivenDetail and results OrientedAbility to Understand business needs and translate them into effective solutionsCapable of working independently with minimal supervisionStrong organization...
People Technology Analyst
HelloConnect,
Taguig
21 hours ago
About UsHelloConnectHelloConnect is a subsidiary of HelloFresh, founded to address years of challenges faced in its own customer care. Leveraging our extensive experience in developing customer care tailored to the immediate needs of HelloFresh, our solutions are hyper-focused on serving high-growth companies. Located in Manila, Philippines, we are now making this service available to other companies to benefit from our...
Human Resources – People & Culture, Employee Relations, Learning & Development
HR TechX Corp.,
Taguig
1 day ago
Location: BGC, TaguigSchedule: Night Shift (9 PM 6 AM) | Monday to FridayWork Setup: Full OnsiteJob Type: Full-timeSalary Range: PHP 25,000 PHP 50,000 per month (depending on role and experience)Are you a people-first HR professional who thrives in dynamic environments? Were building a high-impact People & Culture Team that champions employee experience, learning and development, operational excellence, and strategic HR...
