Claims Adjudication Specialist

TakeCare Asia Philippines, Inc.; Manila; On-site; PHP 290,000 - 424,000; Full time

Job summary

TakeCare Asia Philippines, Inc. is seeking a Claims Production professional to review and adjudicate medical claims, ensuring payments align with authorization, guidelines, and coding standards.

You will analyze records, maintain accuracy targets, adhere to HIPAA, and generate daily production reports for management; collaboration with Customer Service and Claims teams to resolve inquiries and improve turnaround times.

Qualifications

• Reviews claims daily based on medical necessity and guidelines.
• Prepares and adjudicates claims with accurate procedure/revenue and ICD-10 codes.
• Maintains a 98% claims processing accuracy rate.
• Strict compliance with HIPAA rules and protections of PHI.

Responsibilities

• Analyze, process, adjust, and adjudicate claims with correct codes under provider and member benefits.
• Respond to inquiries from internal departments and external providers in a timely and courteous manner.
• Resolve provider or physician group claims inquiries and document resolutions.
• Create and maintain a daily production report of all reviewed claims and update management.

Job description

TakeCare Asia Philippines, Inc. is seeking a Claims Production professional to review and adjudicate medical claims, ensuring payments align with authorization, guidelines, and coding standards.

You will analyze records, maintain accuracy targets, adhere to HIPAA, and generate daily production reports for management; collaboration with Customer Service and Claims teams to resolve inquiries and improve turnaround times.