Medical Claims Processor / Claims Specialist / Medical Claims Specialist

🌟 We're Hiring : Provider Dispute Claims Processor! 🌟

We are seeking an experienced Provider Dispute Claims Processor this role is responsible for reviewing, researching, adjudicating medical claims and resolving provider disputes in compliance with regulatory guidelines and internal policies. This role requires strong analytical skills, a high level of accuracy, and the ability to work independently in a fast-paced

environment. The ideal candidate must have experience either medical claims processing or provider dispute resolution, or a combination of both. This position plays a critical role in maintaining provider satisfaction and ensuring compliance with dispute resolution timelines.

📍 Location : Makati, Philippines

⏰ Work Mode : Work From Office

💼 Role : Provider Dispute Claims Processor

Location : Makati (In-Office Training Required | Potential for Remote Work After Training)

Expected Start Date : December 8, 2025

Salary : up to Php 30,000

What You'll Do :

 Review and adjudicate provider-submitted medical claims for

accuracy, completeness, and compliance with payer policies and

regulatory standards.

 Investigate and resolve provider disputes related to denied,

underpaid, or incorrectly processed claims

 Ensure proper application of coding standards (ICD-10, CPT, HCPCS)

and billing rules.

 Identify and correct claim errors, duplicates, and mismatches in

provider data.

 Process claims adjustments, reprocessing, and corrections as

needed.

 Maintain detailed and accurate documentation of claim decisions and

actions taken.

 Deliver 98%+ accuracy in claims adjudication while exceeding

turnaround time (TAT) and quality standards, ensuring optimal service

and compliance outcomes.

What We’re Looking For :

 High school diploma or equivalent (associate or bachelor’s degree is a plus).

 Minimum 5 years of experience either medical claims

processing / adjudication or provider dispute resolution, or combination of both is a MUST

Technical Skills :

 Proficient in CPT, ICD-10, and HCPCS coding validation; experienced

in handling Medicare claims and secondary coverage.

 Familiarity with other EHR platforms such as Epic, Meditech, or similar is a plus.

 Experienced with platforms such as IDX and Facets.

 Strong understanding of Medi-Cal, Medicare, and commercial insurance billing and claims processes.

 Proficient in Microsoft Office Suite (Excel, Outlook, Word).

Regulatory Knowledge :

 Understanding of healthcare compliance standards, HIPAA, and

payer-specific guidelines.

Core Competencies :

 Strong analytical and problem-solving skills with a high attention to detail.

 Excellent communication skills.

 Ability to manage multiple tasks, prioritize effectively, and meet strict deadlines.

 A collaborative mindset with the ability to work cross-functionally with internal teams.

Requirements & Work Arrangement :

 Amenable to work graveyard hours / night shift

 Can start ASAP . This is an urgent hiring.

 Work Arrangement : This position is currently offered on a

remote work basis after successful completion of training (In-

office). However, please note that this is a performance-based role,

and the company reserves the right to require employees to report

onsite at any time based on business needs, performance evaluations,

operational requirements. Flexibility to transition to an office-based

setup when necessary is expected.

Additional Benefits :

 HMO - Medical & Dental (coverage on Day1 plus 1 dependent)

 Transportation Allowance

 Internet Allowance

 Equipment will be provided

Ready to make an impact? 🚀 Apply now and let’s grow together!