Overview
Healthcare Claims Analyst Jobs in Philippines at DOXA Talent
Title: Healthcare Claims Analyst
Company: DOXA Talent
Location: Philippines
Our client is looking for a Healthcare Claims Analyst who will be responsible for accurately and efficiently reviewing contracts, researching healthcare provider claims, thoroughly documenting investigation results, and identifying and implementing appropriate and effective resolution strategies.
This role will handle the review and assessment of clinical denials, including review of patient medical information, patient account documents, patient account history, company historical data, provider contracts, and regulations as appropriate. He/she will draft focused, successful appeals, meet, and confer documents, IRO submissions, and when necessary, assist with legal submissions on clinical issues.
SCHEDULE:9:00 AM – 6:00 PM Pacific Daylight Time (12:00 AM – 9:00 AM Philippine Standard Time), follows Philippine holidays
POSITION TYPE:Full Time
WORK ARRANGEMENT:Remote
ESSENTIAL FUNCTIONS
Prioritize voluminous claim review workload
Validate claim status, claim liability, and availability of coverage
Understand concepts of coverage, insurance contract interpretation, and reimbursement methodologies
Process pricing claims
Review and validate coding
Research and analyze information gathered through investigation to identify reimbursement issues, develop solutions, and initiate appropriate claim resolution strategies
Maintain quality and productivity standards as set by the management
Influence others using a positive approach
Work independently with minimal supervision
Perform special projects as requested or as assigned by the pre-litigation services manager
Ensure compliance with the Health Insurance Portability and Accountability Act
QUALIFICATIONS
A bachelor’s degree in the related field is preferred
3-5 years of position-specific related work experience (managed care, revenue cycle, data mining, and/or legal)
3-5 years experience working on hospital claims
Experience with Microsoft Office products
Experience with healthcare provider claims management software is highly preferred
Government payor experience is also preferred
Strong analytical, problem-solving, and research skills
Excellent verbal and written communication skills
Highly detail-oriented with strong organizational skills
A team player with a curious personality
Ability to multitask and thrive in a fast-paced work environment
What awaits you upon securing the position?
Assured allowances
Leave credits
Overtime Pay
Night differential benefits
Comprehensive health and life insurance upon hiring, covering one free dependent
Special anniversary incentives
13th-month salary bonus
We provide the necessary equipment!
Other Details
Work Schedule: Night Shift
Full Time
Permanent WFH set-up
