Deskripsi Pekerjaan
Are you a detail-oriented professional with a passion for U.S. Healthcare operations? Tenet Global Business Center, Inc. is looking for a skilled Claims Adjuster to join our dynamic team in Quezon City. In this pivotal role, you will be responsible for the accurate and timely adjudication of medical claims, ensuring that our healthcare providers and patients receive efficient, high-quality service.
As a Claims Adjuster, you will serve as the first line of defense in maintaining the integrity of our billing processes. You will interpret complex healthcare policies, verify coverage, and reconcile discrepancies with precision. We are looking for an individual who thrives in a fast-paced, metrics-driven environment and possesses a deep understanding of U.S. health insurance industry standards. Join us and contribute to a global mission that improves healthcare delivery for thousands of patients.
Tanggung Jawab
- Adjudicate medical claims in accordance with U.S. healthcare insurance policies and industry regulations.
- Review and interpret Explanation of Benefits (EOB) and medical coding to determine payment eligibility.
- Maintain high accuracy and productivity levels while meeting daily/weekly claim processing targets.
- Identify and investigate claims with potential errors, missing information, or fraudulent activity.
- Communicate effectively with internal teams to resolve complex claim discrepancies.
- Document all findings and adjustments clearly in the claims management system.
- Ensure compliance with HIPAA regulations and company data privacy policies at all times.
Kualifikasi
- Bachelor’s degree in Healthcare Management, Nursing, Pharmacy, or a related field.
- Minimum 1-2 years of experience as a Claims Adjuster or Processor in the U.S. Healthcare industry.
- Proficiency in medical terminology, CPT, ICD-10, and HCPCS coding systems.
- Strong analytical and problem-solving skills with a high attention to detail.
- Excellent written and verbal communication skills in English.
- Ability to adapt to new software platforms and claims processing tools.
- Willingness to work in shifts, including night shifts if required by business needs.