Claims Adjuster - W3
Taguig, National Capital Region, Philippines
3d ago

Job Description

  • Process new claims or modifies existing claims according to the appropriate and applicable action
  • Analyze claims to determine appropriate action to approve or deny a claim for payment
  • Determines accurate payment criteria for clearing pending claims based on defined policies and procedures
  • Research claims to determine appropriate benefit application utilizing established criteria; applies physician contract pricing as needed for entry-level claims
  • Review and address provider inquiries regarding claim adjudication
  • Ability to understand and apply knowledge of medical coding (if applicable) and various medical claims forms to the claims process
  • Demonstrated ability to work on high volume of claims
  • Maintain quality standards
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