Provider Dispute Claims Specialist (Remote After Training)

Imagenet, LLC; Manila; Remote; PHP 446,000 - 670,000; Full time

Benefits offered by this job

HMO - Medical & Dental (Day1 coverage)

Transportation Allowance

Internet Allowance

Equipment provided

Job summary

Imagenet is seeking an experienced Provider Dispute Claims Processor to review, research, and resolve provider disputes in line with regulatory guidelines and internal policies. Training is office-based with a transition to remote work after successful completion.

The role requires hands-on experience with Medi-Cal and commercial insurance claims, strong data analysis skills, and proficiency in CPT/ICD-10/HCPCS coding, plus familiarity with IDX and Facets systems.

Qualifications

• 3–5 years hands-on experience in provider dispute resolution within healthcare, TPA, or health plan settings.
• Proficient in CPT, ICD-10, and HCPCS coding validation; experienced with Medicare claims and secondary coverage.
• Strong background in data analysis and visualization to identify trends, improve workflows, and support decision-making.
• Familiar with HIPAA, data privacy regulations, and basic cybersecurity standards.
• Experience with IDX and Facets claim adjudication systems.

Responsibilities

• Investigate and resolve provider disputes related to denied, underpaid, or incorrectly processed claims.
• Review claims history, adjudication data, and notes using EZCap.
• Interpret health plan policies, provider contracts, and regulatory requirements (Medicare & commercial).
• Reviewed healthcare claims for accuracy and compliance, ensuring timely resolution across multiple specialties.
• Evaluate authorization details and validate codes for claim approval and compliance.
• Detect discrepancies that lead to appropriate denials or adjustments, reducing erroneous payments.
• Collaborate with internal quality auditors to improve claims accuracy.
• Process and review healthcare claims across multiple specialties (Anesthesia, ARI, DME, Facility, MSK, Surgery, PAP Supplies, COB, and Lab).
• Verify eligibility, coverage, CPT codes, and supporting documentation for primary and secondary Medicare claims.
• Identify discrepancies and determine whether to approve, deny, or adjust claims per policy guidelines.
• Maintain 98%+ accuracy in claims adjudication while meeting turnaround time and QA standards.

Skills

CPT/ICD-10/HCPCS

Medicare claims

Data analysis & visualization

IDX & Facets

MS Office Suite

HIPAA compliance

Education

High school diploma or equivalent

Associate or Bachelor's degree in related field

Tools

IDX

Facets

Microsoft Excel

Microsoft Outlook

Microsoft Word

Job description

Imagenet is seeking an experienced Provider Dispute Claims Processor to review, research, and resolve provider disputes in line with regulatory guidelines and internal policies. Training is office-based with a transition to remote work after successful completion.

The role requires hands-on experience with Medi-Cal and commercial insurance claims, strong data analysis skills, and proficiency in CPT/ICD-10/HCPCS coding, plus familiarity with IDX and Facets systems.