Senior Recovery, Resolutions Representative - Taguig City, NCR - 2042141
Avella
Taguig City
6d ago

Primary Responsibilities :

  • Provide claims expertise support by reviewing, researching, investigating, negotiating and resolving all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
  • Analyze, identify trends and provide reports as necessary
  • Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
  • Manage subrogation files
  • Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and / or re-assignment to different work locations, change in teams and / or work shifts, policies in regards to flexibility of work benefits and / or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment).
  • The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

    This is a challenging role with serious impact. You'll need to sort through complex situations to understand and clarify where errors happened or where they may continue to happen.

    It's a fast paced environment that takes focus, intensity and resilience.

    Required Qualifications :

  • College graduate of any course
  • Minimum of 5 years working experience, at least 3 years of which is experience in Claims Investigation (preferably in Healthcare, other industries accepted)
  • Experience with one or more of the following : Claims processingProvider demographic informationInsurance billing practices
  • Experience using claims platforms such as UNET, Pulse, NICE, Facets, Diamond, etc.
  • Moderate work experience within own function
  • Intermediate to advanced experience with Microsoft Office Microsoft Excel (sort and filter data) and Microsoft Word (create and edit documents)
  • Preferred Qualifications :

  • Preferably with working internet connection of at least 15 mbps in case of working from home. The following options are also available : Corporate internet subsidy for those within available and valid serviceable locations, subject to Company Policy Onsite work for those who are amenable to drive or commute to our office locations
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