Claims Processing Executive

Operations; Philippines; On-site; PHP 223,000 - 391,000; Full time

Benefits offered by this job

Fresh training provided

US healthcare exposure

Structured training and support

Career growth opportunities

Team-oriented TES environment

Job summary

Kavi Philippines is seeking a Claims Processing Executive to contact patients, employers, medical representatives, and other responsible parties to gather information for collecting payments on complex claims. You will use end Client’s systems to verify documentation and support timely reimbursements.

Fresh graduates with strong English, attention to detail, and willingness to work on-site with evening shifts will receive full training and growth opportunities in US healthcare BPO.

Qualifications

• Diploma or Bachelor’s Degree in any discipline.
• 0-2 years of work experience in US HC BPO preferred.
• Strong English communication skills (verbal and written).

Responsibilities

• Contact end patients, employers and representatives in the US to gather information to complete the claim.
• Analyze and evaluate complex claims payments using end Client’s proprietary software, systems and tools.
• Enter data accurately using payer documentation to determine reimbursement status.
• Conduct timely telephone follow-up with payers and responsible parties to ensure documentation is received and reimbursements are prompt.
• Prepare correct complex claim initial bill packets or appeals with supporting documentation.

Skills

Communication

Attention to Detail

Autonomy

Administrative Skills

Documentation Skills

Technical Tools

Education

Diploma / Bachelor’s Degree

Tools

MS Office

Client systems

Job description

As part of the Tech Enabled Services (TES) Team of Kavi Philippines, the Claims Processing Executive contacts patients, employees, medicalrepresentatives, and other responsible parties to gather information related to collecting payments for complex claims.

Communication

Attention to Detail

Autonomy

Administrative & Documentation Skills

Technical Tools & Systems

Responsibilities

Contact end patients and their employers and representatives in the US to gather information to complete the claim.

Analyze and evaluate complex claims payments using end Client’s proprietary software, systems and tools

Use payment documentation provided by payers to determine if the medical provider has been reimbursed and perform accurate and timely data entry.

Conduct timely and thorough telephone follow-up with payers and other responsible parties to ensure claims with supporting documentation have been received and facilitate prompt reimbursement.

Prepare correct complex claim initial bill packet or appeal letter using the end Client’s systems tools andsubmit with all necessary supporting documentation to insurance companies.

Assist in obtaining supporting claim documentation, appropriately compiling billing packets, and filing insurance claims.

File and handle confidential documentation and Patient Health Information (PHI); able to adhere and follow all Health Insurance Portability and Accountability Act (HIPAA) mandated guidelines to safeguard data privacy and medical information.

Meet or exceed Client’s monthly Quality Audit metric and Production standard targets consistently.

Collaborate well with other TES team members to improve team efficiency.

Assist with operational research by highlighting process areas of improvement.

Other duties as required.

Must Have

• Diploma / Bachelor’s Degree in any discipline
• 0-2 years of work experience in US HC BPO.
• Strong English communication skills (verbal and written).
• Fast and accurate typing with multitasking.
• Attention to detail and professionalism.
• Willingness to work on-site, evening shifts.

Nice to Have

• US healthcare BPO or claims processing experience.
• Knowledge of HIPAA and PHI handling.
• Proficiency in MS Office and basic client systems.
• Familiarity with billing packets, appeal letters, or insurance documentation.

What's great in the job?

• Open to Fresh Graduates – No extensive experience required; full training is provided.
• US Healthcare Exposure – Gain valuable experience working with US insurance, claims, and healthcare processes.
• Strong Communication Development – Improve your professional English communication through daily calls and coordination.
• Structured Training & Support – Learn industry-standard processes with guidance from experienced team members.
• Career Growth Opportunities – Build a solid foundation for long-term growth in the healthcare BPO industry.
• Team-Oriented Environment – Work closely with supportive colleagues in the TES team.