Medical Claims Examiner

MEDICAL CLAIMS EXAMINER - Potential for Remote Work After Training

Work Setup: In‑Office Training Required
Location: Makati – Valero
Schedule: Monday to Friday (Day Shift, Shifting Hours)

This is an Urgent Hiring, we prioritize who can start ASAP!

ImagenetLLCis a premier healthcare technology company revolutionizingmedical claims processingas well as document management with unparalleled service, security, and efficiency. Our core mission is to help clients reduce costs and increase productivity by providing streamlined solutions in document imaging, data validation, adjudication, and on-demand retrieval of documents and data.

Position Summary:

We are looking for Medical Claims Examiners to join our rapidly growing team in Manila. In this role, you will be responsible for accurately and efficiently processing medical claims in compliance with payer requirements and internal policies.

Experience is requiredfor this position.

Main Duties and Responsibilities:

• Review andadjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies
• Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing.
• Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues.
• Review, evaluate and process all types of claims such as Encounter data, Professional and Institutional Claims for all lines of business e.g., Commercial, Point of Service (POS) Senior/Medicare, Preferred Provider Organization (PPO), Medi-Cal, etc.
• Ensure claims payment & denial accuracy and compliance to turnaround time
• Participate in ongoing training and professional development activities.
• Maintain accurate and detailed records of claims processing activities.
  
• Identify and escalate complex or unusual claims for further review or investigation.
  
• Handle more complex claims with multiple services, providers

Qualifications:

• 2+ years of experienceworking closely with US healthcare claims or in a claims processing/adjudication environment.
• Understanding of health claims processing/adjudication
• Medical terminology strongly preferred
• Understanding of ICD-9 & ICD-10
  
• Ability to perform basic to intermediate mathematical computation routines
  
• Basic MS office computer skills
• Ability to work independently or within a team
• Time management skills
• Written and verbal communication skills
• Attention to detail
• Must be able to demonstrate sound decision-making skills

Requirements & Work Arrangement:

• Can start ASAP. This is an urgent hiring.
  

• Work Arrangement: This position is currently offered on a remote work basis after successful completion of training (In-office). However, please note that this is a performance-based role, and the company reserves the right to require employees to report onsite at any time based on business needs, performance evaluations, operational requirements. Flexibility to transition to an office-based setup when necessary is expected.

Additional Benefits:

• Comprehensive HMO Coverage - Medical & Dental
• HMO coverage on Day 1 plus 1 dependent
• Transportation Allowance
  
• Equipment will be provided
  

Your next career move starts here – submit your application today!

COMPANY OVERVIEW:

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers.

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.