Claims Compliance Specialist | Ortigas Site with Annual Increase!

Connext Global Solutions is a dedicated team of business process outsourcing experts and innovators, with experience in supporting world-class companies in Title and Escrow, Healthcare, Produce Distribution, Retail and Fashion, Design Consulting, and Finance.

We are currently looking for a Claims Compliance Specialist who will be with Connext's Client in the United States of America.

• Competitive compensation
• Perfect Attendance Bonus
• Life insurance
• HMO Insurance
• Great company culture
• Annual Merit Increase
• 25% Night Differential

What is the job?

The Claims Compliance Specialist is responsible for following up on health insurance claims in a timely manner, collecting payment information, and communicating necessary escalations to an onshore agent.

Responsibilities:

• Make claims-related calls for the majority of the workday, documenting outcomes in CollaborateMD and Jira.
• Track and document payment information and the status of medical records, following up biweekly.
• Communicate medical denials, appeal statuses, and department needs to the assigned onshore agent.
• Ensure accuracy in all collected data and documentation processes.
• Handle appeals by following up on their status and reporting outcomes.
• Use a structured tier system to follow up on records, resolve denials, and manage medical documentation.

• No prior professional experience required; however, related experience to medical billing, coding, or healthcare administration are a plus.
• Strong analytical and judgment skills for evaluating refund claims and drafting effective appeals.
• Proven ability to identify, resolve, and manage refund and reimbursement issues promptly.
• Clear written and verbal communication skills for discussing and resolving claim-related matters.
• Committed to improving the accuracy and efficiency of refund processing workflows.
• Excellent time management and multitasking abilities to ensure timely claim resolution.
• Adheres to security protocols to protect sensitive payment information and maintain confidentiality.