Medical Claims Examiner - Remote After Training

Imagenet; Makati; On-site; PHP 360,000 - 480,000; Full time

Benefits offered by this job

HMO Coverage

Day 1 HMO + Dependent

Transportation Allowance

Equipment provided

Job summary

Imagenet is seeking a Medical Claims Examiner to join our Manila team. The role involves accurately processing medical claims in line with payer requirements and internal policies, with a path to remote work after completing training.

We require prior experience in US healthcare claims and strong attention to detail. The job offers in-office training in Makati – Valero, with a shift-based day schedule and the flexibility to transition to remote work based on performance and business needs.

Qualifications

• 2+ years of experience working closely with US healthcare claims or in a claims processing/adjudication environment.
• Understanding of health claims processing/adjudication
• Medical terminology strongly preferred
• Understanding of ICD-9 & ICD-10
• Ability to perform basic to intermediate mathematical computation routines
• Basic MS office computer skills
• Ability to work independently or within a team
• Time management skills
• Written and verbal communication skills
• Attention to detail
• Must be able to demonstrate sound decision-making skills

Responsibilities

• Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies
• Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing.
• Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues.
• Review, evaluate and process all types of claims such as Encounter data, Professional and Institutional Claims for all lines of business e.g., Commercial, Point of Service (POS) Senior/Medicare, Preferred Provider Organization (PPO), Medi-Cal, etc.
• Ensure claims payment & denial accuracy and compliance to turnaround time
• Participate in ongoing training and professional development activities.
• Maintain accurate and detailed records of claims processing activities.
• Identify and elevate complex or unusual claims for further review or investigation.
• Handle more complex claims with multiple services, providers

Skills

US healthcare claims

Claims adjudication

Medical terminology

ICD-9/ICD-10

Time management

Written communication

Verbal communication

Attention to detail

Decision making

Tools

MS Office

Job description

Imagenet is seeking a Medical Claims Examiner to join our Manila team. The role involves accurately processing medical claims in line with payer requirements and internal policies, with a path to remote work after completing training.

We require prior experience in US healthcare claims and strong attention to detail. The job offers in-office training in Makati – Valero, with a shift-based day schedule and the flexibility to transition to remote work based on performance and business needs.