Medical Claims Analyst (Coordination of Benefits - COB)

The Coordination of Benefits (COB) Specialist serves as an investigator and patient advocate, helping patients navigate the complexities of the U.S. insurance system to ensure claims are processed accurately and paid appropriately. This role acts as a concierge and guide, working directly with patients and insurance companies to uncover coverage, determine correct payer sequencing, and resolve claim barriers on the patient’s behalf.

The specialist combines insurance expertise with strong customer service skills to explain complex insurance outcomes clearly, resolve outstanding questions, and reduce unnecessary patient burden. This position plays a critical role in improving cash recovery, claim accuracy, and patient experience.

Essential Responsibilities

• Investigate accounts to identify coverage, payer sequencing, and COB issues impacting claim payment
• Serve as a patient concierge, guiding patients through insurance questions and claim‑related next steps
• Communicate directly with patients using empathetic, clear, and solutions‑focused messaging
• Contact U.S. insurance carriers to verify eligibility, COB order, and coverage details
• Partner with payers to determine requirements for claim processing and payment resolution
• Resolve COB‑related and eligibility denials through rebilling, follow‑up, and documentation
• Translate complex insurance determinations into clear explanations for patients
• Document findings, actions, and outcomes accurately to support end‑to‑end resolution
• Collaborate with internal billing, denial, and Self‑Pay teams to drive timely claim outcomes

Qualifications:

• Completed 2 years of college, preferably in Allied Health courses (BSN, Rad. Tech, Med Tech, PT, Nursing, Occupational Therapy, Respiratory Therapy)
• At least 2 years of experience in U.S. healthcare insurance coordination of benefits, billing, claims, follow‑up, or denial resolution experience within a BPO environment.
• Prior experience speaking directly with patients and insurance companies
• Solid understanding of U.S. insurance concepts and claim workflows
• Customer service mindset with the ability to build trust and rapport with patients
• Investigative problem‑solving approach to insurance and claim resolution
• Ability to clearly explain complex insurance information to non‑technical audiences
• Strong documentation, accuracy, and follow‑through
• HIPAA awareness and confidentiality
• Excellent written and verbal communication skills.
• Preferred but not required:
• Experience supporting Self‑Pay, COB, or eligibility work queues
• Prior hospital or health system revenue cycle experience
• Epic or similar EHR/billing system experience
• Able to work onsite and on rotating shifts.
• With good analytical, problem-solving solving and critical thinking skills.
• Amenable to work onsite (Quezon City) and on night shift.

Benefits

• Competitive Total Rewards Package
• Target variable incentives
• Medical Plan (HMO) from Day 1 of employment with free dependents
• Paid Time-Off Benefits

#R1Philippines #AlltogetherBetter #R1JoinTheJourney

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Our Recruitment Hub is open to process walk-in applications for our QC and Taguig sites:

QC Address: 19th Floor, Cyberpark Tower 2, Cubao, Quezon City

BGC Address: 11th Floor, Alliance Global Tower, BGC, Taguig City

Schedule: 1 PM to 5 PM

*Please bring 2 valid IDs and a copy of your resume.

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NOTICE: Please be informed that NO candidate seeking a job opportunity with R1 Philippines shall be required to pay any amount as a condition for employment at R1.

R1 does not authorize any third party, agency, company or individual to collect money or request any monetary arrangement in order to receive a job at R1.

If you are contacted by someone asking for payment, please do not respond, and contact us at PH HR - Talent Acquisition phh••••••••••••••••••@r1rcm.com or report to our Ethics Point Hotline, by phone or online access Philippines: 18.•••.•••.•411 or contact Com••••••••••@r1rcm.com immediately.