Medical Claims Specialist

Whom you'll work with:

Our client, HaloMD, is leading the healthcare revolution with its cutting-edge telehealth platform. HaloMD connects patients with healthcare providers for online consultations, medication delivery, and laboratory testing. Joining our client's team means becoming a part of a company that is reshaping the future of healthcare. By offering innovative, convenient, and affordable healthcare solutions, HaloMD is making a difference in the lives of people, especially those in remote areas or with limited access to traditional medical care. Join HaloMD, and be part of a mission to make healthcare accessible to all.

Job Description

The  Arbitration Specialis t is responsible for analyzing claims eligible for  arbitration . This individual should possess superior communication and computer skills including familiarity, Microsoft Outlook, Word and Excel. This individual will review, analyze and report reimbursement integrity measures.

Here's an overview of your future role:

Employment Type: Full-time

Schedule: Night Shift (Mon - Fri 09:00 PM - 06:00 AM)

Work Arrangement: Onsite (Makati or Cebu)

What do you need to succeed

• High School degree or equivalent.
• Minimum of 1 year of Medical Billing/Claims Management Experience.

Skills/Specialized Knowledge:

• Knowledge of CPT.
• Knowledge of laws that regulate communication and privacy acts, including HIPAA laws, and understanding of the application of all the above.

What awaits you in this role

• Analyze claim reports to determine claims eligible for  Arbitration for both ERISA/NSA claims as well as state insurance department claims 
• Prepare claims for submission to the appropriate portals for  arbitration  
• Have the ability for re-prioritizing key tasks and meet with manager and director to provide updates of findings and outcomes 
• Work with external vendors such as State Department of Insurance (DOI) personnel and arbitrators to assist with issues and resolutions 
• Complete special projects and other duties as assigned 
• Knowledge of medical terminology 
• Strong computer skills including Microsoft Office with a strong proficiency in Excel spread sheets, using formulas, pivot tables, filters, etc. 
• Strong organizational, analytical, and problem-solving skills 
• Knowledge of the insurance industry 
• Proven success in negotiation and technical writing 
• Professionalism in all dealings, both internal and external 
• Ability to clearly communicate, both verbally and in writing 
• Other duties as assigned

Why choose us

• Day 1 HMO
• Prime office locations
• Standard Emapta and Government benefits
• Exposure to international clients
• Realistic career growth opportunities through Emapta Academy
• Supportive and diverse work environment
• Unlimited free gym access (Makati and Cebu)