Medical Claims & Payment Specialist (Calls Required – Outbound)

• Clark, Pampanga | Onsite | Full-Time

About the Role: Responsible for managing the full claims lifecycle, including submission, follow-ups, and payment posting. This role will involve outbound communication with insurance providers to resolve denials and ensure timely reimbursement.

Key Responsibilities:

• Submit and manage medical claims ( resubmissions).
• Review, edit, and correct claims for accuracy.
• Follow up on denied or unpaid claims.
• Handle claim appeals and resubmissions.
• Post payments and reconcile accounts.
• Communicate with insurance companies via outbound calls.
• Maintain accurate billing and claims records.
• Flag recurring issues and billing discrepancies.

Qualifications:

Experience in medical billing and claims processing.

Familiarity with denial management and resubmissions.

Experience with payment posting.

Strong attention to detail and accuracy.

Comfortable making outbound calls to insurance providers.

Good written and verbal English communication.

Preferred Qualifications :

Experience with US healthcare systems.

Familiarity with CPT, ICD-10, and insurance workflows.