Provider Dispute Claims Specialist (Remote After Training)

Imagenet Phils., Inc.; Makati; Hybrid; PHP 391,000 - 580,000; Full time

Benefits offered by this job

HMO - Medical & Dental (Day 1 coverage

Transportation Allowance

Internet Allowance

Equipment provided

Job summary

Imagenet Phils., Inc. is seeking an experienced Provider Dispute Claims Processor to review, research, and resolve provider disputes in accordance with regulatory guidelines and internal policies. The role emphasizes accuracy and timely adjudication across Medi-Cal and commercial plans.

The ideal candidate has hands-on claims processing experience, proficiency with IDX or Facets, and strong Excel skills. Remote work is available after successful training; in-office training is required initially

Qualifications

• At least 3–5 years of hands-on provider dispute resolution experience in healthcare, TPA, or health plan settings.
• Proficient in CPT, ICD-10, and HCPCS coding validation; Medicare and secondary coverage experience.
• Experience with denials, adjustments, and appeals processes; strong authorization and eligibility knowledge.
• HIPAA, data privacy regs, and basic cybersecurity awareness.
• Solid data analysis and visualization skills to identify trends and improve workflows.
• Experience with IDX or Facets for claims adjudication; Microsoft Excel mastery.

Responsibilities

• Investigate and resolve provider disputes related to denied, underpaid, or incorrectly processed claims.
• Use EZCap to review claims history, adjudication data, and notes.
• Interpret health plan policies, provider contracts, and regulatory requirements (Medi-Cal and commercial).
• Review healthcare claims for accuracy and ensure timely resolution across multiple specialties.
• Evaluate authorization details and validate codes to ensure approval and compliance.
• Detect discrepancies leading to denials or adjustments to reduce erroneous payments.
• Collaborate with internal quality auditors, improving claims accuracy by 15% in the first year.
• Process and review claims across specialties (Anesthesia, ARI, DME, Facility, MSK, Surgery, PAP Supplies, COB, Lab).
• Verify eligibility, coverage, CPT codes, and supporting documentation for Primary and Secondary Medicare claims.
• Identify discrepancies and decide to approve, deny, or adjust per policy and medical necessity.
• Maintain 98%+ accuracy in adjudication while meeting turnaround times.

Skills

CPT/ICD-10/HCPCS coding validation

Provider dispute resolution

HIPAA & data privacy

Data analysis & visualization

Education

High school diploma

Associate or Bachelor's degree preferred

Tools

IDX

Facets

Microsoft Excel

Microsoft Office Suite

Job description

Imagenet Phils., Inc. is seeking an experienced Provider Dispute Claims Processor to review, research, and resolve provider disputes in accordance with regulatory guidelines and internal policies. The role emphasizes accuracy and timely adjudication across Medi-Cal and commercial plans.

The ideal candidate has hands-on claims processing experience, proficiency with IDX or Facets, and strong Excel skills. Remote work is available after successful training; in-office training is required initially