Senior Claims Adjudication Specialist

Tenet Global Business Center, Inc.; Quezon City; On-site; PHP 300,000 - 600,000; Full time

Job summary

Tenet Global Business Center, Inc. is seeking an experienced claims reviewer to ensure accurate and timely review of complex claims in line with contracts, regulations, health plan requirements, policies and procedures, and generally accepted business practices.

You will analyze professional and hospital claims, review provider contracts, handle correspondence, and support customer service with escalated issues in a fast-paced managed care environment.

Qualifications

• Experience with general office equipment and Windows PC environments.
• Strong understanding of health and managed care concepts in claims adjudication.
• Proficient in ICD-9-CM, CPT, HCPCS, RBRVS coding and medical terminology.

Responsibilities

• Analyzes professional and hospital claims for accuracy per thresholds and quality standards.
• Reviews authorization and provider contracts and adjudicates claims accordingly.
• Handles correspondence, follow-up, and projects assigned by claims supervisor.
• Supports customer service with escalated member issues.

Skills

Office equipment experience

Health care concepts

Medical coding knowledge

Job description

Tenet Global Business Center, Inc. is seeking an experienced claims reviewer to ensure accurate and timely review of complex claims in line with contracts, regulations, health plan requirements, policies and procedures, and generally accepted business practices.

You will analyze professional and hospital claims, review provider contracts, handle correspondence, and support customer service with escalated issues in a fast-paced managed care environment.