Medical Claims Examiner

MEDICAL CLAIMS EXAMINER - Potential for Remote Work After Training

Work Setup: In‑Office Training Required
Location: Makati – Valero
Schedule: Monday to Friday (Day Shift, Shifting Hours)

This is an Urgent Hiring, we prioritize who can start ASAP!

ImagenetLLC is a premier healthcare technology company revolutionizing medical claims processing as well as document management with unparalleled service, security, and efficiency. Our core mission is to help clients reduce costs and increase productivity by providing streamlined solutions in document imaging, data validation, adjudication, and on-demand retrieval of documents and data.

Position Summary:

We are looking for Medical Claims Examiners to join our rapidly growing team in Manila. In this role, you will be responsible for accurately and efficiently processing medical claims in compliance with payer requirements and internal policies.

Experience is required for this position.

Main Duties and Responsibilities:

• Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies
• Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing.
• Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues.
• Review, evaluate and process all types of claims such as Encounter data, Professional and Institutional Claims for all lines of business e.g., Commercial, Point of Service (POS) Senior/Medicare, Preferred Provider Organization (PPO), Medi-Cal, etc.
• Ensure claims payment & denial accuracy and compliance to turnaround time
• Participate in ongoing training and professional development activities.
• Maintain accurate and detailed records of claims processing activities.
• Identify and escalate complex or unusual claims for further review or investigation.
• Handle more complex claims with multiple services, providers

Qualifications:

• 2+ years of experience working closely with US healthcare claims or in a claims processing/adjudication environment.
• Understanding of health claims processing/adjudication
• Medical terminology strongly preferred
• Understanding of ICD-9 & ICD-10
• Ability to perform basic to intermediate mathematical computation routines
• Basic MS office computer skills
• Ability to work independently or within a team
• Time management skills
• Written and verbal communication skills
• Attention to detail
• Must be able to demonstrate sound decision-making skills

Requirements & Work Arrangement: 

• Can start ASAP. This is an urgent hiring.

• Work Arrangement: This position is currently offered on a remote work basis after successful completion of training (In-office). However, please note that this is a performance-based role, and the company reserves the right to require employees to report onsite at any time based on business needs, performance evaluations, operational requirements. Flexibility to transition to an office-based setup when necessary is expected.

Additional Benefits:

• Comprehensive HMO Coverage - Medical & Dental
• HMO coverage on Day 1 plus 1 dependent
• Transportation Allowance
• Equipment will be provided

Your next career move starts here – submit your application today!

About Imagenet

Imagenet is a technology-forward healthcare operations partner with more than 25 years of experience helping healthcare payers manage critical administrative and operational processes. Founded in 2000 and headquartered in Tampa, Florida, Imagenet supports 150+ health plans through its payer clients.

Our teams help improve efficiency, accuracy, visibility, and service across complex healthcare operations, including digital mailroom, claims adjudication, contact center, member communications, and related administrative functions. By combining experienced operational teams, proven processes, and purpose-built workflow technology, Imagenet helps payers keep essential processes moving for the members, providers, and communities they serve.

Imagenet operates 10 secure facilities across the U.S. and one secure facility in Manila, Philippines.

Joining Imagenet means contributing to work that supports the healthcare operations members and providers rely on every day.