Claimis Processor (HMO Company) - Pampanga
Angeles City, Pampanga
Posted 3 days ago
- Company:
- DEMPSEY DIRECT HIRING COMPANY
- Company Description:
- Welcome to DEMPSEY DIRECT HIRING COMPANY, a leading firm dedicated to connecting top talent with exceptional job opportunities. Our direct hiring approach streamlines the recruitment process, ensuring that we efficiently match candidates with roles that align with their skills and aspirations. With a commitment to fostering professional growth, we prioritize building strong relationships with both clients and candidates. Join us as we shape the future of recruitment, one successful placement at a time.
- Contract Type:
- Full Time
- Experience Required:
- 1 year
- Education Level:
- Bachelor’s Degree
- Number of vacancies:
- 1
Job Description
(Sta. Ana Balibago Angeles City Pampanga Office)
Work Schedule: Mon-Fri 8:30am-5:30pm
Salary Offer: 16, 000
Responsibilities:
➢ Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual
agreements and regulatory guidelines.
➢ Verify member eligibility and benefits coverage for submitted claims.
➢ Evaluate medical documentation to assess the appropriateness of services rendered and coding
accuracy.
➢ Adjudicate claims accurately and efficiently within established turnaround times.
➢ Identify and investigate potential fraudulent or abusive billing practices.
➢ Communicate claim decisions, payment details, and denials to providers and members effectively.
➢ Collaborate with other departments, such as Provider Relations and Customer Service, to resolve
claim-related issues and inquiries.
➢ Maintain comprehensive and organized claim records, documentation.
- Salary:
- 16.000,00 ₱ Monthly