Medical Claims Examiner – Remote after Training

About the role

We are seeking a Medical Claims Examiner to join our fast‑growing healthcare technology team in Makati. After completing an in‑office training program, the role can be performed remotely, focusing on accurate processing of US medical claims in compliance with payer requirements.

Key responsibilities

• Review and adjudicate medical claims, ensuring correct coding, data entry, and reimbursement application.
• Verify patient eligibility, provider credentials, and coverage details.
• Communicate with internal stakeholders to resolve discrepancies and request additional information.
• Process various claim types, including encounter data, professional and institutional claims across commercial, POS, Medicare, PPO, and Medi‑Cal lines.
• Maintain claim payment and denial accuracy while meeting turnaround time targets.
• Escalate complex or unusual claims for further investigation.

Required profile

• Minimum 2 years experience in US healthcare claims processing or adjudication.
• Strong understanding of health claims workflows and medical terminology.
• Familiarity with ICD‑9 and ICD‑10 coding systems.
• Ability to perform basic to intermediate mathematical calculations.
• Proficient with Microsoft Office and able to work independently or within a team.

Required skills

• Health claims processing
• Medical terminology
• ICD‑9 coding
• ICD‑10 coding
• Microsoft Office

What we offer

• Remote work arrangement after successful training.
• Opportunity to work in a dynamic, technology‑driven environment.
• Continuous training and professional development.