Insurance Claims Specialist, Medical Claims and Denials (Night Shift, Onsite)

Sound Connection Phils. Inc.; Cebu City; On-site; PHP 391,000 - 446,000; Full time

Benefits offered by this job

HMO and health insurance

Night differential and holiday premium

Service incentive leave

Weekends off

Direct hire

Job summary

Staff Outsourcing Solutions in Cebu City seeks an Insurance Claims Specialist for Medical Claims and Denials to work night shift onsite. The role handles medical insurance claims, denials, and appeals for US-based accounts receivable teams.

Six openings exist, with a salary package of PHP 35,000 to 40,000 per month plus a performance bonus up to $750 monthly. The ideal candidate has at least 1 year of medical claims experience, strong denial processing skills, and precise English for payer

Qualifications

• At least 1 year of solid experience in medical claims (provider side).
• Hands-on knowledge of denial processing is required.
• Ability to communicate in written and verbal English for payer calls and claim notes; accuracy matters.

Responsibilities

• Review, process and manage medical insurance claims.
• Handle denial processing and resolve claim issues promptly.
• Ensure compliance with insurance standards and policies.
• Work with internal teams to clarify and elevate claim discrepancies.
• Track outstanding claims with insurance companies.
• Contact payers to inquire about claim status, address delays, and resolve issues.
• Follow up with insurance carriers to determine denial reasons and work the claim to payment.
• Analyze unpaid medical claims and denials to determine actions needed to resolve them on time.
• Investigate denial reasons, identify errors, and take corrective action, including submitting appeals.

Skills

Medical claims

Denial processing

English communication

Job description

Insurance Claims Specialist, Medical Claims and Denials (Night Shift, Onsite Cebu). Six openings.

Salary package: PHP 35,000 to 40,000 a month, plus a performance bonus of up to $750 a month.

A Claims Specialist maximizes the collection of outstanding insurance payments for services rendered by a healthcare provider. On a dedicated team in Cebu that works provider accounts receivable for a United States healthcare revenue cycle company, you review, process and manage medical insurance claims, follow up with insurance carriers, work denials to resolution and submit appeals, so the provider is paid for the care it delivered. We are adding six team members to this team now. Night shift aligned to United States business hours, onsite in Cebu Business Park, Monday to Friday.

What success looks like

Twelve months in, the claims on your list move. You know why each unpaid claim is unpaid, what action clears it, and you take that action on time. Your denial work stands up, your appeals are complete and accurate the first time, your follow-up notes let anyone pick up an account where you left it, and your collections and quality numbers hold steady month after month. You keep to the procedures and compliance standards on every claim, and you raise a pattern of denials to the team lead before it becomes a backlog.

What you will do

• Review, process and manage medical insurance claims.
• Handle denial processing and resolve claim issues promptly.
• Ensure compliance with insurance standards and policies.
• Work with internal teams to clarify and elevate claim discrepancies.
• Track outstanding claims with insurance companies.
• Contact payers to inquire about claim status, address delays, and resolve any issues hindering payment.
• Follow up with insurance carriers by phone, portal and correspondence to determine the reason for a claim denial and work the claim to payment.
• Analyze unpaid medical claims and denials, identify and investigate the reasons for nonpayment, and determine the action needed to resolve them on time.
• Analyze and resolve denied claims: investigate the reasons for denial, identify errors or discrepancies, and take corrective action, including submitting appeals.

What we are looking for

• At least 1 year of solid experience in medical claims (provider side), not life, auto, dental, DME or pharmacy claims.
• Hands-on knowledge of denial processing is required.
• Workable written and verbal English for payer calls and claim notes; this is a claims role, not a customer service role, so accuracy matters more than polish.
• Organized, accurate, and able to follow procedures carefully.
• Living in Cebu and available onsite in Cebu Business Park on the night shift, Monday to Friday.

Preferred background: Provider Accounts Receivable; Medical Billing; Billing and Collections; Revenue Cycle Management (RCM).

You may know this role as: Medical Claims Specialist, Insurance Follow‑Up Representative, AR Follow‑Up Specialist, Denials and Appeals Specialist, Provider Accounts Receivable Specialist, Medical Biller, Claims Analyst, or Revenue Cycle Specialist.

Who does well here

The people who do well on this team are organized and exact. They read a remittance or a denial reason and know what to do next, they keep a clean record of every touch, and they work their list in order instead of picking the easy claims. They follow the payer's rules and the team's procedures carefully, because a shortcut costs a claim. They ask when a denial reason is unclear rather than guessing, they show up for every shift on time, and they keep the same accuracy on the last claim of the night as on the first. They are open to new tools, including AI tools that take the routine parts of the job off their plate, and they flag a payer problem to the team lead before it becomes a backlog.

What you get: Salary package of PHP 35,000 to 40,000 a month plus a performance bonus of up to $750 a month, with salary appraisals; HMO and health insurance; night differential and holiday premium pay; service incentive leave upon regularization; a Monday to Friday schedule with weekends off; stable full-time employment as a direct hire, with real opportunity and growth; and a healthy work environment with employee engagement activities.

About Staff Outsourcing Solutions: we build dedicated teams in Cebu for businesses in the United States and Australia. Our team members work inside our clients' daily operations in customer service, sales, accounting, technical support, and specialist roles. We hire for experience and character, we develop interns from partner colleges into full team members, and we keep the same team with a client for years. Founded in 2010, we have grown mostly by referral, which only happens when clients and team members stay. Office: MDCT Building, Leyte Loop, Cebu Business Park, Cebu City. Website: staffoutsourcing.com. Careers: staffoutsourcing.com/careers/job-posting. Posted by Chris Rush, founder.

Staff Outsourcing Solutions never asks applicants for payment, training fees, or personal documents before a written job offer.