8 Medical Claims jobs in the Philippines

Designation

Quality Analyst

Subordinate

Team Leader

Job Level

Intermediate

Department

Medical Billing/AR

Reporting to

Senior Operations Manager

PURPOSE OF THE POSITION

The Quality Analyst (QA) in the Healthcare Accounts Receivable (AR) and Medical Billing team plays a critical role in maintaining service excellence by ensuring compliance with billing standards, payer guidelines, and internal processes.

The QA monitors work quality, provides actionable feedback, and partners with operations and training teams to drive performance improvements and reduce error rates. This role serves as a key checkpoint in the quality lifecycleensuring claims are handled accurately and efficiently, supporting timely revenue recovery for our clients.

RESPONSIBILITIES

• Audit a daily sample of billers' case transcripts.

• Document audit results in a standardized tracker and ensure 

  completeness and consistency of findings.
• Identify patterns and recurring errors from audit results and escalate major discrepancies or compliance risks to Team Leads or Ops Managers.

• Collaborate with TLs and Trainers to align on recurring issues and plan targeted coaching or refresher training sessions.

• Support calibration sessions to maintain scoring alignment with 

  client and operational leads.

• Provide clear and structured feedback to specialists based on audit results.

• Handle QA-related inquiries, audit appeals, validate audit logic, 

  and update feedback if necessary.

• Generate and analyze daily, weekly, or ad hoc QA reports to provide insights on team quality trends and process bottlenecks.

• Flag outliers, productivity-to-quality gaps, and compliance risks in collaboration with Operations and Training.

• Prepare QA summaries for client-facing decks and internal reviews as needed.

• Partner with Trainers and Operations to conduct joint root cause analysis and process refinement.

• Participate in internal syncs, updates, or policy briefings to stay aligned with client expectations.

• Support internal and external calibration sessions and provide QA representation in client or compliance reviews.

JOB REQUIREMENT

• Fluent in English (C1 level or above), with strong communication and leadership skills.
• Excellent verbal and written communication skills in English, with the ability to express ideas clearly and concisely.
• Be detail-oriented with strong analytical skills; Proficient skills with MS Office and Google Drive.
• Minimum of 1 year experience in healthcare AR, revenue cycle, or medical billing, with at least 1 year in a leadership role (external candidate).
• In-depth knowledge of billing practices, payer guidelines, denial management, and compliance standards (e.g., HIPAA).
• Strong analytical, decision-making, and problem-solving skills.
• Comfortable using billing systems, claim portals, and productivity monitoring tools.
• Ability to thrive in a fast-paced, client-driven environment.
• Able to work on Holidays is preferable.

The STL is expected to mentor team leaders, manage escalations, guide productivity, and help improve operational workflows based on data insights and volume trends. They serve as a key link between operations, quality, training, and client-facing functions.

RESPONSIBILITIES

• Lead, coach, and mentor multiple Team Leads and their AR specialists.
• Conduct regular touchpoints, performance reviews, and one-on-one check-ins to guide development and reinforce process standards.
• Collaborate with the QA/Training team to ensure new process updates, payer guidelines, or regulatory changes are cascaded effectively.
• Monitor roster adherence, shrinkage, and floor coverage to ensure staffing efficiency.
• Participate in calibration sessions and collaborate with stakeholders to drive process consistency and best practices.
• Use operational reports and dashboards to analyze productivity, identify gaps, and implement improvement plans.
• Support the rollout of new tools, documentation practices, and training initiatives.
• Ensure that team KPIs such as Call per hour target, productive hours and accuracy.
• Prepare performance and trend reports to share with clients or leadership, including recommendations for continuous improvement.
• Be approachable and available to team members, promoting open communication and support.
• Promote a culture of collaboration, accountability, and continuous learning.

JOB REQUIREMENTS

• Bachelors degree or equivalent work experience
• Fluent in English (C1 level or above), with strong communication and leadership skills.
• Minimum 2 to 3 years of experience in healthcare AR, revenue cycle, or medical billing, with at least 1 year in a leadership role.
• In-depth knowledge of billing practices, payer guidelines, denial management, and compliance standards (e.g., HIPAA).
• Strong analytical, decision-making, and problem-solving skills.
• Comfortable using billing systems, claim portals, and productivity monitoring tools.
• Ability to thrive in a fast-paced, client-driven environment.

Job Information:

You are in charge of leading and supervising a group of content moderators. Guarantee that content guidelines are followed, a secure and polite online environment is maintained, and any platform policy violations are addressed, this function entails monitoring and directing the moderating staff.

The Senior Team Leader for Moderation is crucial in preserving the integrity of online platforms and making sure that users are treated with respect and safety. To address new concerns and maintain round-the-clock moderation coverage, this role may entail working erratic hours, including evenings and weekends.

Location : Muntinlupa, Metro Manila, Philippines (Full-time & On-site)

Key Responsibilities:

• Manage, inspire, and mentor a group of content moderators along with TLs.

• Hold regular team meetings, evaluate performance, and offer helpful criticism.

• Manage escalations and challenging situations while advising and supporting moderators.

• Make sure that all content moderation tasks are completed smoothly and effectively.

• Keep up with platform rules and regulations and make sure the team follows them.

• Keep an eye on the correctness and quality of the content, pointing out any shortcomings.

• Implement quality assurance procedures to uphold strict criteria for moderation.

• To ensure consistency and correctness, conduct audits and evaluations of the moderator's actions.

• Conduct briefings & process updates to the team to improve their abilities.

• Work together to update and improve the content rules and policies with the content policy team.

• Inform the moderation of any modifications to the policy.

• Manage client escalations and reverts to the client mails immediately.

• Should make himself approachable for moderators.

• Report any issue, challenges directly to the reporting manager immediately.

• Will be responsible for checking the roster adherence of moderators and managing shrinkages of the floor.

• Leading team meetings, asking questions to Teamleaders, moderators to better understand the representatives are receiving, educating and coaching workers regarding processes and practices, and explain expectations to moderators.

• Assisting the team members in identifying trend analysis and establishing call center goals.

• Ensure the team members are achieving daily productivity and desired service levels as per the KPIs and incase of any deviation correct action plan to be shared.

• Prepare reports and analyze call center data to improve processes, ensure resources are properly allocated based on the volume trend analysis and maximize the call center efficiency.

• Attention to details, decisiveness & soft spokenness.

• Proficiency with the necessary technology, including computers, software applications, phone systems, etc.

Qualifications and Requirements:

• A bachelor's degree in a field (such as communications, psychology, sociology, or a similar field) that is applicable.

• Fluent in English. At least C1 level.

• Excellent verbal and written communication skills in English and Bengali, with the ability to express ideas clearly and concisely.

• A track record in content moderation or a related industry.

• Strong team management and leadership abilities.

• Excellent interpersonal and communication abilities.

• Proficiency with software and tools for moderating.

• Problem-solving and analytical thinking skills.

• Understanding of the rules and regulations for internet platforms.

• Ability to manage delicate material and perform under pressure.

• Knowledge of the moral and legal issues involved in content moderation.

Benefits:

• Competitive salary and benefits package.

• Opportunities for professional development and continuing education.

• Fulfilling and rewarding work helping individuals improve their mental well-being.

• Contribution to the overall mental health and wellness of the community.