Claims Specialist

Access Care Proactive Health; Central Visayas; On-site; PHP 240,000 - 360,000; Full time

Job summary

Access Care Proactive Health seeks a Claims Assistant Specialist to support insurance claims processing, payment reconciliation, patient eligibility verification, and scheduling across dental and vision platforms. This role also coordinates dentist credentialing and maintains provider data for mobile and event clinics.

You will verify coverage, manage Open Dental records, and collaborate with insurance providers and cross-functional teams.

Qualifications

• Bachelor's degree in Commerce or related field.
• 1 year of experience in insurance claims processing and scheduling support.
• Familiarity with dental and vision insurance workflows and portals.

Responsibilities

• Monitor claim payments daily across multiple insurers and track statuses.
• Submit and process vision claims to Spectera with accuracy and compliance.
• Assist with claim submissions for Cigna and MetLife as needed.
• Coordinate dentist credentialing, attestations, and tracking in Airtable.
• Maintain dentist license numbers and NPI data in Open Dental for compliance.

Skills

Insurance claims processing

Payment reconciliation

Patient eligibility verification

Scheduling coordination

Provider credentialing support

Open Dental

Airtable

Microsoft Office

Data management

Communication

Education

Bachelor of Science in Commerce, Major in Business Management

Tools

Open Dental

Airtable

Microsoft Office

Job description

About the role

The Claims Assistant Specialist is responsible for supporting insurance claims processing, payment reconciliation, patient eligibility verification, provider credentialing coordination, and appointment scheduling operations across multiple dental and vision insurance platforms. This role ensures accurate claims submission, timely payment tracking, provider data management, and operational support for mobile and event-based clinics.

Key responsibilities

• Proactively monitor claim payments daily by accurately tracking all received payments, denied claims, and claim statuses across Cigna, MetLife, and Spectera

• Process and submit vision claims to Spectera, ensuring accuracy, completeness, and compliance with submission guidelines

• Assist with Cigna and MetLife claim submissions whenever additional support is needed

• Collaborate with the Recruitment Team to support the dentist credentialing process by managing attestations, conducting timely follow-ups on attestation forms, coordinating with Brittany via email, and maintaining accurate tracking updates in Airtable

• Maintain accurate documentation of dentist license numbers and NPI information in Open Dental to support compliance and accurate claims processing

• Coordinate with Cigna and Spectera to verify patient eligibility and resolve discrepancies when coverage information is not available in the insurance portal

• Accurately verify and interpret Spectera vision benefits to confirm patient coverage before treatment

• Ensure the accuracy of daily patient schedules by validating patient information, provider and clinic assignments, and recent bookings; onboard new patients in Open Dental and verify insurance eligibility prior to appointments

• Perform patient eligibility verification for all event sites one week prior to scheduled events before plotting appointments in Open Dental

• Contact Cigna Customer Service to verify and confirm patient eligibility when necessary

About you

• Bachelor of Science in Commerce, Major in Business Management

• At least 1 year of experience in insurance claims processing, payment reconciliation, patient eligibility verification, scheduling coordination, and administrative support

• Familiarity with dental and vision insurance claims, insurance eligibility verification, payment posting, provider credentialing support, and healthcare administrative processes

• Proficient in Open Dental, insurance portals (Cigna, MetLife, and Spectera), Airtable, Microsoft Office applications, and data management systems

• Strong verbal and written communication skills with the ability to coordinate effectively with insurance representatives, providers, and cross-functional teams

• Excellent attention to detail, problem-solving abilities, and the capacity to manage multiple tasks while maintaining accuracy and efficiency

• Professional, dependable, and able to maintain confidentiality while building positive working relationships with colleagues and external partners

• Ability to work in a fast-paced environment, prioritize responsibilities effectively, and quickly adapt to changing operational and scheduling demands