(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.
