Claim Resolution Specialist - QC / Pasig

The Claim Resolution Specialist holds a dynamic position within the claims workflow, responsible for submitting appeals to reverse denials and initiate payments, as well as assessing the need for additional actions, such as further appeals or account closures. Individuals in this role may prioritize their tasks based on the complexity of claims and their current workload, ensuring maximum productivity while adhering to compliance and accuracy standards. By effectively managing a high volume of low-balance claims, the specialist guarantees compliance, precision, and revenue recovery that contribute to the success of our clients.

Job Responsibilities:

• Appeal Submission and Resolution: Develop and present comprehensive and convincing appeals for rejected claims, utilizing payer guidelines, contracts, fee schedules, and medical records to resolve issues and facilitate payments.
• Escalation Management: Hand...