Claims Examiner (Hybrid)

Private Advertiser; Philippines; On-site; PHP 300,000 - 420,000; Full time

Benefits offered by this job

Comprehensive HMO Coverage - Medical &

Dental

Job summary

Imagenet in Manila is seeking Medical Claims Examiners to join our expanding team. You will process medical claims accurately, apply payer policies, and ensure compliance with internal guidelines.

The role requires at least 2 years in US healthcare claims, knowledge of ICD-9/ICD-10, and strong math and communication skills. You will handle multiple claim types and maintain detailed records while meeting turnaround times.

Qualifications

• 2+ years of experience working closely with US healthcare claims or in a claims processing/adjudication environment.
• Understanding of health claims processing/adjudication.
• Medical terminology strongly preferred.
• Understanding of ICD-9 & ICD-10.
• Ability to perform basic to intermediate mathematical computation routines.
• Basic MS office computer skills.
• Ability to work independently or within a team.
• Time management skills.
• Written and verbal communication skills.
• Attention to detail.

Responsibilities

• Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies
• Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing
• Communicate with internal resources and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues
• Review, evaluate and process all types of claims such as Encounter data, Professional and Institutional Claims for all lines of business e.g., Commercial, POS Senior/Medicare, PPO, Medi-Cal, etc.
• Ensure claims payment & denial accuracy and compliance to turnaround time
• Participate in ongoing training and professional development activities
• Maintain accurate and detailed records of claims processing activities
• Identify and escalated complex or unusual claims for further review or investigation
• Handle more complex claims with multiple services, providers

Skills

US healthcare claims

Medical terminology

ICD-9/ICD-10

Mathematical skills

MS Office

Independent work

Time management

Communication skills

Attention to detail

Job description

About the role

We are looking for Medical Claims Examiners to join our rapidly growing team in Manila. In this role, you will be responsible for accurately and efficiently processing medical claims in compliance with payer requirements and internal policies.

Key responsibilities

• Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies
• Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing
• Communicate with internal resources and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues
• 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
• Participate in ongoing training and professional development activities
• Maintain accurate and detailed records of claims processing activities
• Identify and escalated complex or unusual claims for further review or investigation
• Handle more complex claims with multiple services, providers

About you

• 2+ years of experience working closely with US healthcare claims or in a claims processing/adjudication environment
• Understanding of health claims processing/adjudication
• Medical terminology strongly preferred
• Understanding of ICD-9 & ICD-10
• Ability to perform basic to intermediate mathematical computation routines
• Basic MS office computer skills
• Ability to work independently or within a team
• Time management skills
• Written and verbal communication skills
• Attention to detail

Benefits

• Comprehensive HMO Coverage - Medical & Dental
• HMO coverage on Day 1 plus 1 dependent
• Transportation Allowance
• Equipment will be provided

About us

Imagenet is a technology-forward healthcare operations partner with more than 25 years of experience helping healthcare payers manage critical administrative and operational processes. Founded in 2000 and headquartered in Tampa, Florida, Imagenet supports 150+ health plans through its payer clients. Our teams help improve efficiency, accuracy, visibility, and service across complex healthcare operations, including digital mailroom, claims adjudication, contact center, member communications, and related administrative functions. By combining experienced operational teams, proven processes, and purpose-built workflow technology, Imagenet helps payers keep essential processes moving for the members, providers, and communities they serve. Imagenet operates 10 secure facilities across the U.S. and one secure facility in Manila, Philippines.