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Claims Examiner
Claims Examiner
Claims Examiner
Date Posted:
2010-06-30
Call Center Company: Imagenet Philippines
Description:
Imagenet Philippines is looking for individuals who are qualified for the position of Claims Examiner.
Successfuly applicants for Claims Examiner will have a great career in Imagenet Philippines.
Responsibilities:
Demonstrate compliance on all aspects of claims processing as mandated by Centers for Medicare and Medicaid Services(CMS), Department of Managed Health Care ( DMCH), Department of Human Services (DHS) and clients' affiliated Health plans
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.
Enter claims data in claims processing system and review entry for correct adjudication according to patient benefit coverage and provider contracts.
Investigate and research claims as necessary to determine or verify member's eligibility, benefit coverage and required authorizations.
Issue Claims Disposition ( Payment, denial or request for additional information).
Deny unathorized and/or ineligible claims according to client's guidelines (provider denials vs member-liability denials)
Reprice claims( multiple surgical reduction, assistant surgeon, rebundling/unbundling etc.)
Ensure claims payment & denial accuracy and turnaround time.
Requirements:
Candidate must possess at least a Bachelor's/College Degree , Nursing or any allied course
At least 2-3 year(s) medical claims processing experience.
Strong medical background preferred
Ability to analyze data to determine problems and suggest solutions.
Ability to work under pressure and manage a large workload
Ability to adjust to changes in method, processes and procedures
Ability to navigate multiple software applications simultaneously
Ability to work independently and effectively under pressure
Assertive, self-directed and resourceful
Call Center Directory advises to all job seekers to apply as walk-in applicant for Claims Examiner job opening of Imagenet Philippines.
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Reviews supporting documents to determine validity of medical claims.
Encodes information into computerized claims system.
Identifies problems with claims (e.g., missing docume
Perot Systems need Business Process Associate for its BPO operations.
Qualification:
college graduate of any 4 year course
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-Claims Analysis , Insurance & Patient A/R follow-up
Requirements:
-Graduates/Post Graduates with 6 months to 2 years experience in claims processing in Insurance/Healthcare se
Career or Profession? In EXL, you don't have to choose. Practice your medical or financial profession while building your career in the BPO industry.
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JOB SUMMARY:
• Ensures delivery of excellent customer service through accurate processing of customers requests, communication, and coordinating with other departments to resolve inquiries
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