Medical Claims Examiner

Location: Must be based in Makati, Philippines. The role requires in-office training with the potential for remote work thereafter, subject to performance and business needs.

Company

hirify.global is a premier 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 professional and institutional medical claims.
• Verify patient eligibility, provider credentialing, and coverage details.
• Ensure accurate coding and application of reimbursement methodologies.
• Communicate with internal stakeholders to resolve claim discrepancies.
• Maintain detailed records of processing activities and ensure compliance with turnaround times.
• Identify and escalate complex or unusual claims for further investigation.

Requirements

• 2+ years of experience in US healthcare claims processing or adjudication.
• Understanding of ICD-9 and ICD-10 coding.
• Ability to perform basic to intermediate mathematical computations.
• Proficiency in MS Office and strong attention to detail.
• Must be able to start ASAP and commit to in-office training in Makati.
• Strong written and verbal communication skills.

Nice to have

• Prior knowledge of medical terminology.
• Experience with various lines of business such as Medicare, PPO, or Medi-Cal.

Culture & Benefits

• Comprehensive HMO coverage for employee and one dependent starting on Day 1.
• Transportation allowance provided.
• Necessary equipment for the role is supplied by the company.
• Professional development and ongoing training opportunities.