Medical Claims Medical

Equicom Services Inc.; Makati; On-site; PHP 201,000 - 357,000; Full time

Benefits offered by this job

Paid Training

HMO upon regularization

Paid SL & VL upon regularization

5 days of work

Paid SL & VL upon regularization

Job summary

A leading services provider in Makati is seeking a Medical Claims Processor to ensure timely processing of claims and evaluate them based on benefits. Responsibilities include completing assigned claims, ensuring quality for approval, and adhering to organization’s data privacy policies. Ideal candidates are graduates of medical-related courses or undergraduates at least at the third-year level, with strong communication skills and a willingness to learn. Training will be provided, and the role requires onsite work.

Qualifications

• Open for fresh graduates.
• Willing to be trained.
• Willing to be assigned in Makati & Binondo.
• Ability to multi-task while working under minimal supervision
• Computer literate with proficiency in MS Office, using MS Word and Excel
• Willing to be trained
• With Strong analytical skills
• Willing to be assigned in Makati & Binondo

Responsibilities

• Ensure that claims assigned are completed within turnaround time.
• Evaluate the claims based on Account's Benefits.
• Correct tagging of pending claims.
• Process and adjudicate the claims assigned
• Evaluate the claims based on Account's Benefits
• Ensure to meet daily/weekly/monthly target production
• Ensure that all returned claims from Claims QC - IP are correctly edited
• Ensure the quality of claims to be submitted for approval
• Escalate scanning-related issues
• Correct tagging of pending claims
• Return claims that are not valid for process to provider/hospital
• Comply with the organization’s information security and data privacy policies, procedures, and guidelines to ensure the protection of sensitive data, safeguarding the confidentiality, integrity, and availability of all information. This includes adhering to established protocols for securely handling, storing, and transmitting data while ensuring compliance with applicable legal and regulatory requirements
• Attend mandatory annual Information Security (InfoSec) and Data Privacy Act (DPA) awareness training to stay informed about the latest security practices and maintain compliance with relevant obligations

Skills

Excellent oral and written communication skills

Strong analytical skills

Computer literate with proficiency in MS Office

Ability to multi-task while working under minimal supervision

Education

Graduate of any 4 year medical related courses / Undergrad at least 3rd year level

Tools

MS Word

MS Excel

Job description

Equicom Services, Inc. is now looking forMedical Claims Processorwho can work onsite.

Office Address:3F Equicom Center 3308 Zapote St., Brgy. Sta. Cruz, Makati City

Qualifications

• Graduate of any 4 year medical related courses / Undergrad at least 3rd year level
• Open for fresh graduates
• Excellent oral and written communication skills
• Ability to multi-task while working under minimal supervision
• Computer literate with proficiency in MS Office, using MS Word and Excel
• Willing to be trained
• With Strong analytical skills
• Willing to be assigned in Makati & Binondo

What to expect?

• Paid Training
• Full time and onsite
• 5 days of work
• HMO upon regularization
• Paid SL & VL upon regularization

Primary Duties and Responsibilities

• Ensure that claims assigned are completed within turnaround time
• Ensure that batches are completed and uploaded
• Prioritize completion of PPD, Aging, and ASAP Batches
• Process and adjudicate the claims assigned
• Evaluate the claims based on Account's Benefits
• Ensure to meet daily/weekly/monthly target production
• Ensure that all returned claims from Claims QC - IP are correctly edited
• Ensure the quality of claims to be submitted for approval
• Escalate scanning-related issues
• Correct tagging of pending claims
• Return claims that are not valid for process to provider/hospital
• Comply with the organization’s information security and data privacy policies, procedures, and guidelines to ensure the protection of sensitive data, safeguarding the confidentiality, integrity, and availability of all information. This includes adhering to established protocols for securely handling, storing, and transmitting data while ensuring compliance with applicable legal and regulatory requirements
• Attend mandatory annual Information Security (InfoSec) and Data Privacy Act (DPA) awareness training to stay informed about the latest security practices and maintain compliance with relevant obligations