169 Medical Claims jobs in the Philippines
Medical Claims
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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
Medical Claims
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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
Insurance and Medical Claims Specialist
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MUST:
- Candidates should have at least 2 years of insurance agency or broker experience.
- Must be an advanced user of Microsoft Excel and CRM tools.
- Must have experience in any of the following: Claims Management / Claims Processing/ Insurance Claims / Medical Claims Review
- Must have knowledge about State Workers' Compensation Laws
The position manages and maintains workers' compensation policies for assigned clients, ensuring compliance, timely renewals, accurate invoicing, and proper classification codes. This role involves updating CRM systems, submitting payroll reports, and supporting audits and internal teams. Familiarity with US workers' compensation policies a must.
Essential Duties:
- Oversees the administration of workers' compensation policies including monopolistic state policies.
- Ensures administered policies remain in force and in good standing.
- Updates the customer relationship management system with all workers' compensation policy information for assigned clients.
- Ensures tasks are created/current for each assigned client in the customer relationship management system.
- Submits payroll reports to carriers as required per the terms of each policy.
- Ensures all premium invoicing is completed each month in a timely fashion.
- Submits needed policy changes to the broker/carrier.
- Works with auditors to complete all required policy audits.
- Ensures all assigned policies are renewed timely.
- Responsible for ensuring class codes are proper for all assigned policies.
- Assists with the cancellation of workers' compensation policies when needed.
- Assists the payroll department in addressing payroll system errors relating to administered workers' compensation policies.
Medical Claims Analyst
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About the role
Become a key member of the Medical Claims team at access healthcare, a dynamic and growing healthcare provider based in Pasay City, Metro Manila. In this full-time role, you will be responsible for analysing and processing medical claims to ensure accurate and timely reimbursements for our patients.
What you'll be doing
- Review and evaluate medical claims for accuracy, completeness, and compliance with insurance policies and procedures
- Communicate with insurance providers and patients to resolve any issues or discrepancies with claims
- Maintain detailed records and documentation of all claims processed
- Assist in the development and implementation of improved claims processing workflows and procedures
- Collaborate with the medical and billing teams to provide high-quality customer service
- Stay up-to-date with changes in healthcare regulations and insurance policies
What we're looking for
- Minimum 2 years of experience in medical claims processing or a related field
- Strong analytical and problem-solving skills to identify and resolve issues efficiently
- Excellent communication and interpersonal skills to liaise with insurance providers and patients
- Proficient in using medical coding systems and claims management software
- Familiarity with healthcare regulations and insurance policies
- Attention to detail and ability to work accurately under tight deadlines
- Bachelor's degree in healthcare administration, business, or a related field
What we offer
At access healthcare, we are committed to providing our employees with a supportive and rewarding work environment. Some of the key benefits include:
- Competitive salary and performance-based bonuses- Comprehensive health insurance coverage- Opportunities for career advancement and professional development- Flexible work arrangements to support work-life balance- Collaborative and inclusive company culture
About us
access healthcare is a leading provider of integrated healthcare services in the Philippines. Our mission is to deliver high-quality, accessible, and affordable healthcare to the communities we serve. With a growing network of medical facilities and a team of dedicated healthcare professionals, we are committed to improving the well-being of our patients and the communities we serve.
If you are passionate about healthcare and are eager to join a dynamic and forward-thinking organisation, we encourage you to apply for this exciting opportunity. Click the "Apply now" button to submit your application.
Medical Claims Processor
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Medical Claims Processor
Responsible in processing health claims - either reimbursements, OP, or IP claims.
Job Responsibilities:
- Adjudicate, evaluate, and process claims in a timely manner in accordance with the insurance policy and program.
- Attend to concerns related to claims, reimbursements, and computations.
- Initiate improvement processes.
Qualifications:
- Graduate of any 4-year medical course
- With background on medical claims evaluation and adjudication.
- With relevant exposure in health insurance or HMO industry.
- Willing to work in Alabang, Muntinlupa.
- Work schedule is M-F, 8 am to 5 pm. Currently we are on a hybrid set up and we report onsite 3x a week.
Please contact HR at , both on mobile or Viber to inquire more about the job.
Medical Claims Processor
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JOB PURPOSE:
Responsible for analyzing, adjudicating, auditing and processing of claims (In-Patient, Out-Patient Hospital Bills and Professional Fees) according to set medical guidelines, policies within the agreed SLAs (Service Level of Agreements)
- Graduate of Bachelor of Science in Nursing or any related medical course (FRESH GRADUATES ARE WELCOME TO APPLY)
- Above average communication and interpersonal skills
- Must be customer-service oriented.
- With expertise/familiarity with medical terminologies
- Computer literate
- With experience in claims processing and reconciliation
- Willing to accept fixed term contract
- Willing to work onsite in Makati City
Medical Claims Processor
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Job Description:
Short Description:
- Review and verify the accuracy and completeness of submitted medical claims, including patient information, provider details, services rendered, and billed amounts.
- Assess the coding accuracy of diagnoses, procedures, and services according to industry-standard code sets such as ICD-10, CPT, and HCPCS.
- Determine the eligibility of claims based on contract terms, insurance coverage, and medical necessity criteria. Process claims for payment or denial accordingly.
- valuate supporting documentation, such as medical records and invoices, to validate the services billed and ensure compliance with coding guidelines.
- Investigate and resolve discrepancies or discrepancies in claim submissions, collaborating with internal teams, providers, and insurers as needed.
Minimum Requirements:
- Minimum of 2 years' experience
- Above average english communication skills
NOTE: This role is Dayshift and requires 15 days a year on-site.
Job Types: Full-time, Permanent
Pay: Php27, Php30,000.00 per month
Benefits:
- Work from home
Work Location: Remote
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Medical Claims Processor
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- Senior high school graduates with relevant experience in medical billing is welcome to apply.
- 1 year of experience in medical billing is required for this position.
- Willing to work onsite, night shift schedule.
Job Type: Full-time
Benefits:
- Health insurance
- Life insurance
- Opportunities for promotion
- Paid training
- Promotion to permanent employee
- Staff meals provided
Application Question(s):
- What are your salary expectations?
- Years of experience in medical billing.
- Can start ASAP.
Work Location: In person
medical claims associate
Posted today
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Position: Medical Claims Associate
Location: Cocolife Building, Ayala Avenue, Makati City
Work Setup: Onsite Monday - Friday 8am- 5pm
Job Summary:
We are looking for a detail-oriented and reliable individual to join our team as a CLAIMS ASSOCIATE. The successful candidate will be responsible for the evaluation and prompt processing of medical claims.
Qualifications:
- Graduate of any medical-allied course (Fresh graduates are welcome to apply)
- Acceptable medical-allied courses include Nursing, Medical Technology, Physical Therapy, Pharmacy, Radiologic Technology, or any health-related course
- Associate degree holders with relevant healthcare/claims experience are encouraged to apply
- Preferably with background in healthcare claims processing or medical billing
- Strong attention to detail and organizational skills
- Willing to work onsite at Cocolife Building, Ayala Makati
BENEFITS
- Guaranteed 15th month bonus plus performance incentives
- Free group life insurance coverage upon hiring
- Medical allowances and free HMO for the employee upon regularisation
- With separation and retirement benefits for tenured employees
- Monthly rice allowance
- Clothing Allowance
- Additional leave (5-days mental health break/ Wellness Leave)
- 30 days leave
- Company Christmas gift
- Company events
- Health insurance
- Life insurance
- On-site parking
- Opportunities for promotion
- Pay raise
- Promotion to permanent employee
- Bonus pay
- Overtime pay
- Performance bonus
Medical Claims/Analyst
Posted today
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Job Description
About the role
As a Medical Claims/Analyst - Healthcare Customer Service Representative at access 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