Claims Processing Executive

Operations; Philippines; On-site; PHP 279,000 - 424,000; Full time

Job summary

Kavi Philippines, part of the Tech Enabled Services (TES) team, seeks a Claims Processing Executive to contact patients and providers in the US, analyze complex claims, and handle PACS data with HIPAA compliance. You will perform timely data entry, follow up with payers, and prepare billing packets.

Your role emphasizes attention to detail, strong English communication, and the ability to work on-site during evening shifts while collaborating with the TES team for efficient operations.

Qualifications

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

Responsibilities

• Contact end patients, employers and representatives in the US to gather information to complete the claim.
• Analyze and evaluate complex claims payments using the client’s proprietary software and tools.
• Use payer documentation to determine reimbursement and perform accurate data entry.
• Follow up with payers to ensure documents are received and reimbursements processed.
• Prepare complex claim initial bill packets or appeal letters with supporting documentation.
• Assist in obtaining supporting claim documentation and filing insurance claims.
• Handle confidential PHI and adhere to HIPAA guidelines.
• Meet or exceed monthly quality audit and production targets.
• Collaborate with TES team members to improve efficiency.
• Support operational research to highlight process improvements.
• Other duties as required.

Skills

English communication

Typing

Attention to detail

Autonomy

Team collaboration

Multitasking

Education

Diploma / Bachelor's degree in any discipline

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.