Deskripsi Pekerjaan
Are you a seasoned professional in healthcare claims looking for an opportunity to lead and make a significant impact? Imagenet Phils., Inc., a leading provider of essential healthcare support services, is actively seeking a highly skilled and dedicated Healthcare Claims Supervisor to join our dynamic team in Makati City. This is an exceptional onsite opportunity to spearhead and optimize our end-to-end medical claims adjudication functions, primarily supporting critical US health plan operations.
In this pivotal role, you will be instrumental in ensuring the efficient, accurate, and compliant processing of medical claims. You will lead a team of dedicated claims specialists, providing expert guidance, fostering professional development, and implementing best practices to achieve operational excellence. Your leadership will directly contribute to the seamless delivery of healthcare services, impacting the lives of thousands of beneficiaries in the US.
We are looking for a proactive leader with a deep understanding of healthcare claims processing, regulatory compliance, and team management. If you thrive in a fast-paced environment, possess exceptional analytical skills, and are passionate about driving quality and efficiency in healthcare operations, we encourage you to apply. Join Imagenet Phils., Inc. and be part of a company that values expertise, innovation, and a commitment to service excellence.
Tanggung Jawab
- Lead, supervise, and mentor a team of claims adjudicators, ensuring high performance and adherence to service level agreements.
- Oversee the end-to-end medical claims adjudication process for US health plans, including receipt, processing, and resolution.
- Conduct regular audits of claims processing to ensure accuracy, compliance with regulatory guidelines (e.g., HIPAA), and payer-specific policies.
- Identify and implement process improvements to enhance efficiency, reduce errors, and optimize claims turnaround times.
- Provide expert guidance and support to the team on complex claims issues, denials, appeals, and escalations.
- Develop and deliver training programs for new and existing claims staff to ensure continuous skill enhancement and knowledge updates.
- Monitor key performance indicators (KPIs) and generate reports on team productivity, claims backlog, and quality metrics.
- Collaborate with internal departments and external clients to resolve issues and ensure smooth claims operations.
Kualifikasi
- Bachelor's degree in Healthcare Administration, Business, or a related field.
- Minimum of 3-5 years of progressive experience in medical claims processing, with at least 1-2 years in a supervisory or team lead role.
- Demonstrated expertise in US healthcare claims adjudication, including understanding of CPT, ICD-10, and HCPCS coding.
- Strong knowledge of US health plan regulations, compliance standards (e.g., HIPAA), and payer policies.
- Proven ability to lead, motivate, and develop a team in a high-volume, deadline-driven environment.
- Excellent analytical, problem-solving, and decision-making skills.
- Exceptional communication (written and verbal) and interpersonal skills.
- Proficiency in claims management software and MS Office Suite.