CLAIMS PROCESSOR

Salary not specified

IMAGENET PHILIPPINES, INC.
Apply now
CITY OF MAKATI, NCR, FOURTH DISTRICT
COLLEGE GRADUATE
Permanent

Job Description

Posted on 31 July 2024
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
 

Qualifications/Requirements

To join our team,
  • Candidate must possess at least a Bachelor's/College Degree
  • With experience in US claims processing
  • 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
  • with available home internet ( work from home set up)

Work location

CITY OF MAKATI, NCR, FOURTH DISTRICT

Remarks

Additional Benefits:
  • 13th Month Pay
  • HMO (Medical and Dental Coverage)
Apply now
About the company

Imagenet is a premier healthcare technology company that has taken medical claims processing and document management to new levels of service, security and efficiency. Our core business is helping our clients reduce costs and increase productivity by providing efficient document imaging, data valida...

Industry

OTHER COMMUNITY, SOCIAL AND PERSONAL SERVICE ACTIVITIES

Employment size

200 and over (Large)

View company profile

Share job

Back to jobs