Senior Claims Adjudicator: Complex Claims Expert

Tenet Global Business Center, Inc.; Quezon City; On-site; PHP 240,000 - 360,000; Full time

Job summary

Tenet Global Business Center, Inc. in Manila is seeking a Claims Processor to ensure the accurate and timely review of complex claims in line with contracts, regulations, health plan requirements and established procedures.

Responsibilities include analyzing claims for accuracy against thresholds, reviewing contracts, adjudicating claims, handling correspondence, and assisting customer service with escalated member issues.

Qualifications

• 2-3 years claims experience in a managed care environment.
• 3-5 years claims processing UB-04 and professional experience.
• 3-5 years Medicare, Medicaid, Medical, Commercial, PPO and HMO claims experience.

Responsibilities

• Analyzes professional and hospital claims for accuracy according to set dollar thresholds and meets and maintains production and quality standards.
• Reviews authorization and/or provider's contract and adjudicates claims accordingly.
• Perform any correspondence, follow-up and any projects delegated by claims supervisor.
• Provide assistance to the customer service department with escalated member issues.

Skills

Claims processing

Health plan knowledge

ICD-9-CM CPT HCPCS

Managed care

Communication

Tools

MS Windows

Job description

Tenet Global Business Center, Inc. in Manila is seeking a Claims Processor to ensure the accurate and timely review of complex claims in line with contracts, regulations, health plan requirements and established procedures.

Responsibilities include analyzing claims for accuracy against thresholds, reviewing contracts, adjudicating claims, handling correspondence, and assisting customer service with escalated member issues.