Medical claims examinerImagenet Philippines Inc

Salary Details
PHP 23,000
Job Address
14th/F Valero Tower 122, Valero Street Salcedo Village Makati City
Job Description
Responsibilities:
Enter claims data in the claims processing system and review entry for correct adjudication according to patient benefit coverage and provider contracts.
Responsible for following applicable regulatory and internal policies in claims adjudication.
Investigate and research claims as necessary to determine or verify members’ eligibility, benefit coverage and required authorizations.
Deny unauthorized and/or ineligible claims according to client’s guidelines (provider denials vs. member-liability denials).
Ensure claims payment and denial accuracy within turnaround time.
Review, evaluate and process all types of claims such as Encounter data, Professional and Institutional Claims for all lines of business e.g., Commercial, Point of Service (POS) Senior/Medicare, Preferred Provider Organization (PPO), Medi-Cal, etc. 
Ensure claims payment & denial accuracy and compliance to turnaround time
 
Requirements:
Candidate must possess at least a Bachelor's/College Degree
With experience in US claims processing
 Knowledge of EZ CAP an advantage
Ability to analyze data to determine problems and suggest solutions
Ability to work under pressure and manage a large workload
Ability to adjust to changes in method, processes and procedures
Ability to navigate multiple software applications simultaneously
Ability to work independently and effectively under pressure
Assertive, self-directed, and resourceful
Willing to work on graveyard shift, holidays and weekends if required
Job Type
Customer Service/BPO
Working Hours
06:00 AM to 02:00 PM
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NCR, Metro Manila, Makati, Philippines
3 Years
Full-time
PHP 23,000
Bachelor's / College Degree
5 Vacancies