Medical Claims Examiner

TL;DR

Medical Claims Examiner: Processing and adjudicating medical claims in compliance with payer requirements and internal policies with an accent on accurate coding, data validation, and reimbursement methodology application. Focus on resolving claim discrepancies, verifying patient eligibility, and ensuring payment accuracy for various lines of business including Medicare and PPO.

Location: Must be based in Makati, Philippines (Hybrid: In-office training required, potential for remote work after training).

Salary: Up to ₱27,000

Company

hirify.global is a healthcare technology company providing back-office support, claims processing, and document management solutions to over 70 health plans nationwide.

What you will do

• Review and adjudicate medical claims for accuracy in coding and reimbursement.
• Verify patient eligibility, provider credentialing, and coverage details.
• Communicate with internal stakeholders to resolve claim discrepancies and clarify issues.
• Process various claim types including Encounter data, Professional, and Institutional claims.
• Ensure payment and denial accuracy while meeting strict turnaround time requirements.
• Identify and escalate complex or unusual claims for further investigation.

Requirements

• 2+ years of experience in US healthcare claims processing or adjudication.
• Understanding of health claims processing and adjudication workflows.
• Proficiency in ICD-9 and ICD-10 coding systems.
• Must be able to start by June 15, 2026.
• Must be able to complete in-office training in Makati.
• Basic MS Office skills and ability to perform mathematical computations.

Nice to have

• Knowledge of medical terminology.

Culture & Benefits

• Comprehensive HMO coverage for employee and one dependent starting on Day 1.
• Transportation allowance provided.
• Equipment provided for work.
• Opportunity for remote work transition after successful training completion.