47 Medical Appeals jobs in the Philippines

ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Healthcare Customer Service Representative to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly skilled professionals, who prioritize employee satisfaction and work-life balance. At ISTA Solutions, we pride ourselves on creating a culture focused on long-term success and life-long learning. We're looking for a team player who is ready to contribute to our mission, just like you

Account Specific Roles and Responsibilities:

• Review and process ambulance insurance claims, ensuring accuracy and compliance with client and insurance requirements.
• Work directly with clients to address inquiries, provide updates, and resolve claim-related concerns.
• Verify claim details including eligibility, coverage, and supporting documentation.
• Apply knowledge of medical and diagnosis codes to ensure correct claim submission and adjudication.
• Identify and escalate discrepancies, denials, and appeals as needed.
• Maintain accurate and timely claim records in line with company and client standards.
• Uphold confidentiality and compliance with HIPAA guidelines.

• At least 6 months of Healthcare experience.
• Above average verbal and written English communication skills.
• Medical claims and prior authorization experience preferred but not required.
• Knowledge of medical and diagnosis codes is required.
• Strong attention to detail with a focus on accuracy.
• Ability to work independently while managing multiple tasks.

What Can We Offer You?

• Competitive salary and benefits
• Health Insurance with free dependents
• 10%-night differential
• Attendance Bonus
• Paid Time Off
• Convertible to Cash Leave Credits
• Performance Appraisal
• Work-life Balance
• A focus on growing your career path with us
• We encourage you to follow your passions and learn new skills

Our Commitment To You

• Strong culture and values-driven leadership
• We create opportunities for you to learn and grow at any stage of your career
• Continuous learning and innovation
• We foster an all-inclusive environment where everyone thrives

ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Healthcare Customer Service Representative to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly skilled professionals, who prioritize employee satisfaction and work-life balance. At ISTA Solutions, we pride ourselves on creating a culture focused on long-term success and life-long learning. We're looking for a team player who is ready to contribute to our mission, just like you
Account Specific Roles and Responsibilities:

• Review and process ambulance insurance claims, ensuring accuracy and compliance with client and insurance requirements
• Work directly with clients to address inquiries, provide updates, and resolve claim-related concerns
• Verify claim details including eligibility, coverage, and supporting documentation
• Apply knowledge of medical and diagnosis codes to ensure correct claim submission and adjudication
• Identify and escalate discrepancies, denials, and appeals as needed
• Maintain accurate and timely claim records in line with company and client standards
• Uphold confidentiality and compliance with HIPAA guidelines

Requirements

• At least 6 months of Healthcare experience
• Above average verbal and written English communication skills
• Medical claims and prior authorization experience preferred but not required
• Knowledge of medical and diagnosis codes is required
• Strong attention to detail with a focus on accuracy
• Ability to work independently while managing multiple tasks
• Willing to work onsite in Mandaluyong
• Amenable working night shift

Benefits
What Can We Offer You?

• Competitive salary and benefits
• Health Insurance with free dependents
• 10%-night differential
• Attendance Bonus
• Paid Time Off
• Convertible to Cash Leave Credits
• Performance Appraisal
• Work-life Balance
• A focus on growing your career path with us
• We encourage you to follow your passions and learn new skills

Our Commitment To You

• Strong culture and values-driven leadership
• We create opportunities for you to learn and grow at any stage of your career
• Continuous learning and innovation
• We foster an all-inclusive environment where everyone thrives

ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Healthcare Customer Service Representative to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly skilled professionals, who prioritize employee satisfaction and work-life balance. At ISTA Solutions, we pride ourselves on creating a culture focused on long-term success and life-long learning. We're looking for a team player who is ready to contribute to our mission, just like you

Account Specific Roles and Responsibilities:

• Review and process ambulance insurance claims, ensuring accuracy and compliance with client and insurance requirements.
• Work directly with clients to address inquiries, provide updates, and resolve claim-related concerns.
• Verify claim details including eligibility, coverage, and supporting documentation.
• Apply knowledge of medical and diagnosis codes to ensure correct claim submission and adjudication.
• Identify and escalate discrepancies, denials, and appeals as needed.
• Maintain accurate and timely claim records in line with company and client standards.
• Uphold confidentiality and compliance with HIPAA guidelines.

• At least 6 months of Healthcare experience.
• Above average verbal and written English communication skills.
• Medical claims and prior authorization experience preferred but not required.
• Knowledge of medical and diagnosis codes is required.
• Strong attention to detail with a focus on accuracy.
• Ability to work independently while managing multiple tasks.
• Willing to work onsite in Mandaluyong
• Amenable working night shift

What Can We Offer You?

• Competitive salary and benefits
• Health Insurance with free dependents
• 10%-night differential
• Attendance Bonus
• Paid Time Off
• Convertible to Cash Leave Credits
• Performance Appraisal
• Work-life Balance
• A focus on growing your career path with us
• We encourage you to follow your passions and learn new skills

Our Commitment To You

• Strong culture and values-driven leadership
• We create opportunities for you to learn and grow at any stage of your career
• Continuous learning and innovation
• We foster an all-inclusive environment where everyone thrives

Job Qualifications:

• Completed at least 2 years of college or SHS Graduate.
• Minimum 12 months experience in Healthcare Account Receivable/Collections in a BPO setting.
• Familiarity with UB Claims and UB04 forms.
• Experience in medical billing/AR collections.
• Background in calling insurance (Payer) for claim status and payment disputes.
• Familiar with EPIC SYSTEM.
• Willing to work on-site in Quezon City.
• Experience in a BPO Healthcare Account is required.

Primary Responsibilities:

• Read contracts for payment disputes.
• Work on the provider side.
• Verify claim status and collect unpaid claims from insurance.
• Process claims payments, manage denials, and track claim statuses.
• Manage collections for healthcare unpaid claims.
• Interact with customers to ensure invoice accuracy and resolve claims discrepancies.
• Provide input on policies, systems, methods, and procedures for premium collection management.
• Educate customers on online applications for claims and payments.
• Monitor outstanding balances and ensure clients pay as billed.
• Prepare invoices and reconcile billing with accounts receivables.
• Conduct quality assurance and audits of collection activities.
• Handle documents, emails, and calls related to account processes.
• Perform accounts receivable collections, follow-up, denial management, claims payment processing, tracking, and appeals for hospital processes.

Your role is critical in providing confidence in the exceptional care we offer to our members, families, facilities, and health professionals. This is an everyday opportunity to do your life's best work.

WHAT WE OFFER

• Market Competitive Pay Levels
• Retirement Plan
• Medical Plan (HMO) from Day 1 of employment
• Dental, Medical, and Optical Reimbursements
• Life and Disability Insurance
• Paid Time-Off Benefits
• Sick Leave Conversion
• Tuition Fee Reimbursement
• Employee Assistance Program (EAP)
• Annual Performance Based Merit Increases
• Employee Recognition
• Training and Staff Development
• Employee Referral Program
• Employee Volunteerism Opportunity
• All Mandatory Statutory Benefits

WHO WE ARE

• Optumis the health care technology and innovation company of the UnitedHealth Group enterprise along with UnitedHealthcare.
• UnitedHealth Groupis a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone.
• We're a leading health solution and care delivery organization. Our work is complex, but our mission is simple: create a healthier world, with you at the center.
• As part of a Fortune 5 enterprise, we are improving the health care experience of over 125 million people around the world.
• We're a diverse team with operations across North America, South America, Europe, Asia Pacific and the Middle East. This includes our over 25,000 employees in the Philippines.
• Elevate your career with a leading health care company while improving lives.

Join us in evolving health care so everyone can have the opportunity to live their healthiest life. This is your opportunity to be part of a team that's dedicated to Caring. Connecting. Growing together

Job Purpose

The representative is responsible for collections, account follow up, billing and allowance posting for the accounts assigned to them.

Duties and Responsibilities

• Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.
• Meets and maintains daily productivity/quality standards established in departmental policies.
• Uses the workflow system, client host system and other tools available to them to collect payments and resolve accounts.
• Adheres to the policies and procedures established for the client/team.
• Knowledge of timely filing deadlines for each designated payer.
• Performs research regarding payer specific billing guidelines as needed.
• Ability to analyze, identify and resolve issues causing payer payment delays.
• Ability to analyze, identify and trend claims issues to proactively reduce denials.
• Communicates to management any issues and/or trends identified.
• Initiate appeals when necessary.
• Ability to identify and correct medical billing errors.
• Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process.
• Understanding of under or over payments and credit balance processes.
• Assist with special A/R projects as needed. Analytical skills and the ability to communicate results are required.
• Act cooperatively and courteously with patients, visitors, co-workers, management and clients.
• Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Work independently from assigned work queues.
• Maintain confidentiality at all times.
• Maintain a professional attitude.
• Other duties as assigned by the management team

Qualifications

• Completed at least High School education
• With minimum 1 year of US Healthcare Account Receivable/Collections in a BPO setting or environment (claims payments processing, claims status and tracking, Medical Billing, AR Follow ups, Denials and Appeals-outbound healthcare providers)
• Experienced on medical billing/ AR Collections.
• Background in calling insurance (Payer) to verify claim status and payment dispute.
• Must be amenable to work night shifts.
• Must be amenable to work onsite in Ortigas, Pasig.

What's In It For You:

• HMO on day 1 with dependent(s)
• Free Lunch

Job Type: Full-time

Pay: Php25, Php33,000.00 per month

Benefits:

• Health insurance
• Life insurance

Work Location: In person

About the role

As a Medical Claims/Analyst - Healthcare Customer Service Representative healthcare, you will play a crucial role in providing exceptional customer service and claims processing support to our healthcare clients and their patients. This full-time position is based in Pasay City, Metro Manila, and offers the opportunity to contribute to the efficient operation of our healthcare administration services.

What You'll Do:

• Provide exceptional customer support to patients and providers
• Review, analyze, and process healthcare claims with accuracy
• Resolve inquiries with empathy and professionalism
• Be the voice of trust for our clients in navigating their healthcare journey

What We're Looking For:

• Strong communication skills and a passion for service
• Background in healthcare, insurance, or claims processing (a plus, but not always required)
• Problem-solving mindset and attention to detail
• Willingness to learn and grow in a supportive environment

Why Join Us?

Competitive salary + performance incentives

Comprehensive training & development

Opportunities for career growth in the healthcare industry

Supportive and dynamic team culture

Be part of a career that truly makes a difference—apply now and help us transform healthcare, one claim at a time