[ref. p4291718] US Medical Claims Processor (with QNXT Experience) - Manila

Role: US Medical Claims Specialist - ACTIVE POOLING

Visaya Knowledge Process Outsourcing Corporation is a proudly Filipino organization recognized globally for service excellence, innovation, and a culture of malasakit. We are committed to building long-term partnerships through quality, reliability, and a people-first approach.

Role Overview:

This role requires accuracy, efficiency, and a solid understanding of claims workflows, coding, and compliance standards.

Key Responsibilities:

• Review and process medical claims in Trizetto’s QNXT for accuracy and compliance.
• Validate eligibility, benefits, authorizations, and coding (CPT, ICD-10, HCPCS).
• Investigate and resolve claim discrepancies, denials, and appeals.
• Communicate with providers, payers, and internal teams to clarify issues.
• Maintain accurate documentation of claims activities and resolutions.
• Ensure compliance with HIPAA, company policies, and regulatory requirements.
• Support audits, quality checks, and process improvements.

Qualifications:

• College level education required; bachelor’s degree preferred.
• Minimum of 2 years’ experience in US medical claims processing/claims adjudication.
• Hands-on experience with Trizetto’s QNXT platform is required.
• Familiarity with CPT, ICD-10, and HCPCS coding systems.
• Strong knowledge of US healthcare claims workflows, payer policies, and medical billing standards.
• Excellent analytical, communication, and problem-solving skills.
• Ability to work efficiently with high attention to detail and accuracy.
• Willingness to work onsite in Ortigas on a night shift schedule.

Perks and Benefits:

• 15% Night Differential
• HMO coverage after 30 days of employment (with option to add up to 2 dependents)
• Retirement Benefits
• 24 Leave Credits per year (convertible to cash)
• Wholistic Employee Wellness Program

• Be part of a multi-awarded, 100% Filipino-owned company recognized for its leadership and innovation in the outsourcing industry1.
• Work in a culture that values professional growth, employee well-being, and long-term partnerships.
• Enjoy industry-leading benefits and a supportive, inclusive environment.

Visaya KPO is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.