Medical Call Center Agent jobs in Makati

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Summary
The Customer Service Representative is responsible for supporting healthcare billing and reimbursement operations by managing insurance claims, resolving denials, and conducting accounts receivable follow-up activities. This role ensures timely claim resolution, accurate documentation, and effective coordination with insurance payers, healthcare providers, and internal teams to support efficient revenue cycle processes.

Key Responsibilities

• Review, analyze, and resolve denied, rejected, or unpaid insurance claims.
• Contact insurance companies to verify claim status, appeal denials, and address reimbursement issues.
• Prepare, correct, and resubmit claims through clearinghouse systems as necessary.
• Perform accounts receivable (AR) follow-up activities for outstanding claims and unpaid balances.
• Coordinate with hospitals, clinics, providers, and insurance payers regarding billing discrepancies and claim concerns.
• Monitor claim adjudication, payment activity, and reimbursement status.
• Maintain accurate documentation of claim actions, appeal progress, payer communications, and account updates.
• Identify root causes of denials and recommend corrective or preventive actions.
• Ensure compliance with payer guidelines, client requirements, HIPAA standards, and internal workflows.
• Maintain productivity and quality standards in accordance with client expectations.
• Escalate complex claims, payer disputes, or unresolved billing issues when necessary.

Qualifications

• Experience in medical billing, claims processing, denial management, AR follow-up, or healthcare revenue cycle management preferred.
• Knowledge of insurance claims, reimbursement processes, EOBs, and payer guidelines is an advantage.
• Familiarity with clearinghouses and medical billing systems preferred.
• Strong analytical, organizational, and problem-solving skills.
• Excellent written and verbal communication skills.
• High attention to detail and accuracy in documentation and claim handling.
• Ability to work in a fast-paced, metrics-driven environment.
• Relevant training, certification, or equivalent work experience may be considered in lieu of a degree.

Nice to have

• Experience supporting hospitals, clinics, or multi-site healthcare operations;
• Experience handling US-based payer communications;
• Background in healthcare BPO or offshore healthcare support is an advantage.

Work Setup

• Shift: US Business Hours / Night Shift
• Client: US Healthcare / Texas
• Internet Allowance provided

Pay: Php25,000.00 - Php40,000.00 per month

Benefits:

• Company Christmas gift
• Company events
• Health insurance
• Opportunities for promotion

Application Question(s):

• Are you willing to work on a night shift schedule?
• If currently employed, how long is your notice period?
• What is your expected monthly salary?

Work Location: Remote