Claims Investigation - Quezon City

+We use our shared expertise to deliver innovative solutions in an evolving healthcare setting. · +Competitive Total Rewards Package · , , Target variable incentives, Medical Plan , from Day 1 of employment with free dependents , Life insurance , Paid Time-Off Benefits , Sick Lea ...

Provide analysis and reporting to maintain general ledger functions. Administer general claims and underwriting processing to ensure insurance quotes and proposals are reflected in tracking tools. Support customer service delivery and resolve inquiries pertaining to claim issues. ...

We are seeking a Claims Analyst to join our Insurance Operations team at MBPS. This role is responsible for the overall review and assessment of claims and making independent decisions on payment within defined authority levels. The successful candidate will have strong analytica ...

The FinCrime Analyst is responsible for safeguarding the organization and its customers by identifying investigating and mitigating potential financial crime risks. · Conduct thorough investigations of suspected fraudulent transactions across various payment channels. · Analyze t ...

Responsibilities: · Investigate / root cause on claim denials, payment variances, billing errors, repetitive action codes (AND) (OR) any other scenarios where they observe a gap in process · Identify patterns and trends in claim rejections and delays. · Collaborate with payer sol ...

The Claims Specialist manages claim appeals and evaluates next steps. They prioritize work based on claim complexity and efficiently process high volumes of low-balance claims. · Prepare and submit clear, well-supported appeals for denied claims. · Resolve complex denial issues e ...

· The Claims Specialist manages claim appeals and evaluates next steps—whether submitting additional appeals or closing accounts. They prioritize work based on claim complexity, maintain accuracy and compliance, and efficiently process high volumes of low‑balance claims to suppo ...

· The FinCrime Analyst is responsible for safeguarding the organization and its customers by identifying, investigating, and mitigating potential financial crime risks. This role requires strong analytical skills, attention to detail, and a solid understanding of fraud typologie ...

We're looking for a Claims Analyst to join our Insurance Operations team at MBPS. In this role, you are responsible for the overall review, assessment, and decision on payment for claims. · Position Responsibilities · Responsible for the complete assessment, calculation and final ...

+ · Key Responsibilities: · + Investigate and resolve member grievances related to Medicare Part D drug coverage, claims, and pharmacy issues · + Act as a liaison between members, providers, and pharmacies for Medicare grievance resolution · ,+ Maintain confidentiality of sensiti ...

This role supports complex cases involving claims, remits and attachments transactions. · ...

Job Summary · I. PRIMARY PURPOSE To manage the commercial and contractual administration of assigned Civil / MEP works ensuring correct entitlement effective change management and compliance with contract requirements throughout project delivery. · ...

We live and breathe our mantra: Head, Heart, Hustle. · ...

The Medical Biller (Revenue Cycle Specialist) with deep expertise in full-cycle billing, payer guidelines, denial management, and claims resolution.This individual plays a critical role in optimizing revenue capture, reducing AR, ensuring coding accuracy, and maintaining the fina ...

This is a pharmacy technician job that involves resolving member grievances related to Medicare Part D drug coverage and providing clear communication throughout the grievance process. · ...

The Medical Biller (Revenue Cycle Specialist) with deep expertise in full-cycle billing, payer guidelines, denial management, and claims resolution.This individual plays a critical role in optimizing revenue capture, reducing AR, ensuring coding accuracy, · and maintaining the fi ...

The job is for a pharmacy technician to handle grievances and provide customer support. · ...

I.  JOB MISSION/SUMMARY · To account and reconcile receivable claims / rebate versus credit note payments and is responsible for ensuring the accuracy and completeness of accounts related to funds. This role involves verifying and reconciling customer accounts, investigating disc ...

A Sr Collections Specialist in RCM is responsible for identifying, analyzing and resolving issues related to medical billing, claims processing, denials and payment discrepancies. · ...

Grievance Handling: Investigate and resolve member grievances related to Medicare Part D drug coverage claims pharmacy issues Ensure all grievances are resolved within required CMS timelines documented appropriately Act as a liaison between members providers pharmacies for Medica ...