Claims Resolutions Specialist | Onsite Ortigas with 25% Night Differential

Connext; Pasig; Presencial; PHP 335.000 - 558.000; Jornada completa

Descripción de la vacante

Connext is seeking an experienced Healthcare Claims Resolution Specialist to ensure timely reimbursement and claim resolution for healthcare providers.

You will follow up on claims, investigate denials, and coordinate with insurers to secure reimbursements while maintaining accurate documentation.

Formación

• 2+ years in healthcare claims processing, denial management, or related role.
• Experience with U.S. health insurance claims.
• Strong analytical and problem-solving abilities.
• Excellent written and verbal English communication.
• Ability to prioritize and manage multiple claims with accuracy.

Responsabilidades

• Follow up on health insurance claims and resolve denials through investigation.
• Communicate with payers and use provider portals to obtain claim statuses.
• Track appeals, payments, EFTs, and reimbursement updates.
• Determine when medical records or resubmissions are needed and coordinate internally.
• Document actions and resolution strategies with onshore team.

Conocimientos

Healthcare claims experience

Analytical skills

English communication

Multi-claim management

Attention to detail

Descripción del empleo

Connext is a global outsourcing and staffing company that connects businesses with skilled professionals across various industries. We support our clients by providing talented teams who deliver reliable, high-quality services while building meaningful career opportunities for our people.

About the Role

Are you an experienced Healthcare Claims Specialist who thrives on solving complex claim issues and securing reimbursements? Join our growing team and play a key role in ensuring successful insurance claim resolution for healthcare providers.

As a Healthcare Claims Resolution Specialist, you will be responsible for following up on health insurance claims, investigating denials, and coordinating with insurance companies to ensure timely reimbursement and claim resolution.

Key Responsibilities

• Follow up on health insurance claims and resolve denials through thorough investigation and problem-solving.
• Spend the majority of the workday communicating with insurance payers and utilizing provider portals to obtain claim statuses.
• Conduct regular claim follow-ups and denial resolution activities to ensure timely reimbursement.
• Determine when medical records or claim resubmissions are necessary and coordinate with the appropriate teams.
• Track and document appeals, claim payments, EFTs, VCCs, and reimbursement updates.
• Communicate claim actions and resolution strategies with onshore team members.
• Maintain accurate documentation and stay current with insurance payer guidelines and requirements.

What We're Looking For

• At least 2 years of experience in healthcare claims processing, denial management, medical billing, or a related healthcare insurance role
• Experience working with U.S. healthcare insurance claims
• Strong analytical and problem-solving skills
• Excellent written and verbal English communication skills
• Ability to effectively manage multiple claims and prioritize workload
• High attention to detail and commitment to accuracy

Why Join Us?

• Career growth and development opportunities
• Collaborative and supportive work environment
• Opportunity to make a meaningful impact in the healthcare revenue cycle industry