Medical Claims Examiner – Professional Claims

Imagenet LLC

. Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies .

Posted 10/27/2026full-timeMakati • PhilippinesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical claims processing and adjudication, with a strong understanding of ICD-9 and ICD-10 coding. Proficient in verifying patient eligibility and provider credentialing while ensuring compliance with reimbursement methodologies and turnaround times.

Highest-signal resume keywords

Medical Claims ProcessingICD-9 & ICD-10 UnderstandingClaims AdjudicationAttention to DetailWritten and Verbal Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationICD-9 CodingICD-10 CodingMathematical ComputationData EntryReimbursement MethodologiesClaims Payment AccuracyClaims Denial AccuracyHealthcare Claims ProcessingEncounter Data Processing

Soft Skills

Time ManagementDecision-MakingTeam CollaborationIndependent WorkFlexibility

Tools & Technologies

MS Office

Industry Keywords

Healthcare ClaimsProvider CredentialingPatient EligibilityCommercial ClaimsPOS Senior/Medicare ClaimsPPO ClaimsMedi-Cal Claims

About the role

Key responsibilities & impact

Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies
Verify patient eligibility, provider credentialing, and coverage details
Communicate with internal resources and stakeholders to resolve claim discrepancies, request additional information, or clarify issues
Review, evaluate, and process Encounter data, Professional, and Institutional Claims across Commercial, POS Senior/Medicare, PPO, Medi-Cal, and other lines of business
Ensure claims payment and denial accuracy and compliance with turnaround times
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 complex claims involving multiple services and providers

Requirements

What you’ll need

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
Can start ASAP
Flexibility to transition to an office-based setup when necessary is expected

Benefits

Comp & perks

Comprehensive HMO Coverage - Medical & Dental
HMO coverage on Day 1 plus 1 dependent
Transportation Allowance
Equipment will be provided
Potential for remote work after successful completion of in-office training
Ongoing training and professional development activities