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- ...be responsible for people and project management, carrying out administrative activity required to ensure effective management of claims administration team, payment allocation, claims reserves and total incurred review. The claims lead must know how the team processes...
- Responsibilities: ~- Review diagnosis and medication coding for infusion services, especially when payer limitations apply. - Assess payer medical policies and CMS guidelines to confirm medical necessity and coverage eligibility. ~- Ensure clinical documentation aligns...
- ...initiatives aimed at enhancing coding accuracy, maximizing reimbursement, and standardizing intake workflows. - Train and onboard new Claims Coordinators on systems, procedures, and industry best practices, while providing ongoing mentorship and operational support to...
- ...Arrangement : Hybrid Our East West Insurance Brokerage team is looking for experienced professionals to join us in Taguig as a Claims Assistant . In this role you will process insurance claims filed by bank clients delivering efficient service from initial...
- Back Office Processor (Financial) Position Description The Senior Processor plays a key role in ensuring accurate and efficient administration of financial back-office operations. This position combines processing and compliance responsibilities, covering a wide range...
- ...Determine reimbursement eligibility Apply Medicare and payer guidelines Validate ICD-10, CPT, HCPCS coding Resolve reimbursement/claim issues Support compliance and audits Collaborate with billing, reimbursement, and clinical teams Recommend process...
- Junior Back Office Processor (Financial) Position Description The Junior Processor plays a key role in ensuring accurate and efficient administration of financial back-office operations. This position combines processing and compliance responsibilities, covering a...
- Key Duties & Responsibilities: Responsible for the timely and accurate processing of vendor payments Payments Reviews all invoices for appropriate documentation and approval prior to payment Updates and maintains accurate records in the reports used to collate data ...
ETeam PH
Taguig29 days ago 775000 $ per day
...II. Health Operations New Associate [2] Data entry and processing of claim pre-eligibility information. Should be able to make decisions on whether to release or pend transactions. The Processor will be subject to project standards of quality and productivity as well...- ...Model, Underwriting Workflows, Forms, Rating ClaimCenter — Claim Lifecycle, Coverage Verification, Reserves, Financials BillingCenter... ...integrations including third-party data vendors, payment processors, and document management systems Exposure to test automation...Remote job
- ...external banking partners to resolve payment concerns and transaction issues. Support the management of relationships with payment processors, payout providers, card networks, and alternative payment method providers. Assist in evaluating and supporting the onboarding...
- ...external banking partners to resolve payment concerns and transaction issues. Support the management of relationships with payment processors, payout providers, card networks, and alternative payment method providers. Assist in evaluating and supporting the onboarding...
- ...Previous experience working with JIRA and Confluence . Experience with payment service providers, acquiring platforms, banks, card processors, or financial technology companies. Familiarity with card-scheme certification requirements and regulatory standards....
- Job Summary We are seeking a detail-oriented Travel Claims Processor - Health to join our team. In this role, you will be responsible for reviewing and processing medical claims submitted under travel insurance policies. You will assess claim eligibility, verify supporting...
Risewave Consulting
Muntinlupa11 days ago - ...customer business through contract administration, customer orders, and problem resolution. Customer Service Operations – Document Processor/Intake Team is responsible for providing services to customers relating to document and order processing; delivery; feedback and...
775000 $ per day
...performance when executing transactions ~Processes pre-coded invoices, including those with and without a purchase order. Invoice Processor may be required to process one or all of these types of invoices (with PO, without PO) ~ Ensures that all invoices assigned are...- ...Responsibilities: Clinical Review & Documentation: Analyzing medical records for accuracy, compliance, and appropriateness of care. Claims Processing: Determining patient eligibility, validating medical claims, and managing insurance coverage. Utilization Management:...
- Job Functions: • Input claim data into the system, ensuring all information is accurate, up-to-date, and properly filed. • Assist in collecting and organizing all necessary documentation for claims, including medical reports, receipts, and forms. • Review and assess...
Career Professionals, Inc.
Muntinlupa22 days ago - ...platforms. Vendor Interface Escalate issues and configuration questions directly to Interprose. Collaborate with vendors (payment processors, scrubs, skip tracing, etc.) to resolve issues and ensure timely data processing. Support & Escalation Act as the first line of...
- ...assistance on suite of services like Independence, Conflicts, Compliance, regulatory, policy and security issues as well as dealing with claims and queries regarding ethics. Formed in 2007, the RMS team is growing rapidly as a Center of Excellence for all standardized...
- ...(Net Zero) goals. Responsibilities & Duties Prepare and deliver ad hoc reports and quarterly analysis, including accident claims, Zero ZAPs, and Net Zero compliance metrics. Maintain accurate billing charge numbers for all vehicles, ensuring updates are consistently...
- ...Philippines office" mean something smaller at other companies, that is not what this is. On AI: EviSmart's AI is not a marketing claim. We have in-house model research and development teams, and the tools we use daily — Claude, Cursor, Luvable, LLM-powered workflows...
- ...product catalogue, promo offers, and category trends. Aid the Ecommerce Operations team in arranging special deliveries, filing claims, tracking returns, among others Requirements Strong communication and writing skills. Good coordination and project management...
775000 $ per day
...RESPONSIBILITIES: The person will be responsible for overseeing teams of Processors and Analysts under Order management/Billing and Accounts Receivable/Collections. He/ she has performance oversight for their team and ensures that productivity and quality metrics...- ...At least 1 year of Inpatient OR Outpatient Coding experience Job Description: Conducts thorough analysis and audits of claims by seamlessly integrating medical chart coding principles, clinical guidelines, and an objective approach to ensure precise medical...
- ...appropriate, well supported, and thoroughly documented decisions which may result in the identification of improper payments on paid claims to various providers of clinical services, including outpatient hospital, ambulatory surgical centers, Home Health and DME...
- Job Functions: • Handle more complex or high-priority claims, ensuring all documentation is complete, accurate, and in compliance with relevant policies and regulations. • Process claims within established timelines, ensuring the appropriate action is taken for claim...
Career Professionals, Inc.
Muntinlupa21 days ago - ...candidate will also be required to respond to ad hoc requests from staff. Responsibilities . Monitor various exposure and claim data sets and work with Arch business units and support teams to improve data quality and avoid financial penalties, were possible...
775000 $ per day
...Responsibilities: • Responsible for the activities assigned by the PTP Tower Lead. ? • Understand and perform PTP lead role. ? • Assist PTP processors with questions and problems related to day-to-day transaction processing. • Assist the PTP Tower Lead in supervising the...- ...Job Summary: A Claims Processor is responsible for the accurate and timely processing of claims submitted by clients, policyholders, or claimants. This role involves reviewing claims, verifying documentation, ensuring adherence to company policies, and ensuring...
