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Healthcare Claims Representative

Keywords / Skills : "customer service representative", Inbound And Outbound, "Collections"

1 - 5 years
Posted: 2019-02-11

Customer Service/Call Centre/BPO
Other Customer Service
Non Degree Tertiary
23000 - 26000 PHP
Posted On
11th Feb 2019
Job Description

Responsible for timely and accurate resolution of account receivables either through insurance payment collections or write offs.


• Performs AR follow-up on assigned accounts by ensuring claims are adjudicated accordingly while taking into account Timely Filing Limits set by the payer

• Conducts thorough research on assigned AR accounts through insurance websites/portals and/or by initiating outbound calls to payers

• Submits adjustments or write-off requests for approval to resolve outstanding account balances

• Submits medical record packets for submission to the payer for claims reprocessing, reconsideration or appeal requests

• Receives inbound calls/ call backs from payers/insurances regarding accounts that they are actively working on

• Responds to e-mail inquiries from different departments regarding pending insurance balances or claim denials

• Performs claims resubmission and corrects claim information as necessary

• Maintain accurate and detailed notes/documentation in applicable systems

• Reads and interprets an Explanation of Benefits and relates it to the claim being worked on

• Keeps Supervisor and/or Manager informed of system issues

• Observes legal and ethical guidelines for safeguarding patient and company confidentiality (HIPAA)

• Other duties as assigned


• Proficient in the knowledge of the equipment and services offered by Company.

• Works as a part of the company team by communicating effectively with all departments.

• Provides exceptional customer service to both internal and external customers.

• Promotes company’s culture by adhering to policy, procedure, and mission statement.

• Completes assigned work in a timely and efficient manner.

• Adapts to and demonstrates the ability to deal with frequent changes in the work environment.

• Meets individual, departmental, and company goals.

About Company

At Abbott, diverse ideas, perspectives, and expertise allow us to create the life-changing solutions that help people live healthier lives. In 150 countries and with businesses spanning nutrition, diagnostics, medical devices, and branded generic pharmaceuticals, Abbott offers you enormous opportunities to explore your interests and help you achieve your career and personal goals.
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