Medical Claims Specialist

The leading BPO solutions provider in Leyte, Philippines, Virtual Staffing Solutions, offers a wide-ranging and comprehensive outsourcing solutions from call center services to back-office support, to highly complex data processing for SMEs and large corporations in the US and UK. 

Since its founding in 2018, the team has grown into a strong and competitive player in the BPO scene with over 1500+ employees and counting. Virtual Staffing has built its reputation of flexibility, quality, and industry excellence and has since brought its clients continual success in their business.
Responsibilities:

•  Verify insurance information using relevant portals, IVRs (Interactive Voice Response systems), and phone outreach to individual payers.
•  Thoroughly check and accurately document insurance requirements.
•  Collaborate with the consultation team to provide clear information to prospective clients about their insurance coverage, benefits, and payment options.
•  Accurately determine patient responsibility, benefit limits, and utilization.
•  Maintain and update information in electronic health records and CRM (Customer Relationship Management) systems.
•  Proactively escalate any items that require attention or further action.
• Ensure all work is performed in compliance with company policies, including adherence to HIPAA and other regulatory, legal, and safety requirements.

Requirement and skills:

•  BPO experience in the Healthcare Insurance field, demonstrating a strong understanding of the industry and related processes.
•  Excellent communication skills, both written and verbal, to effectively interact with clients, team members, and other stakeholders.
•  Ability to multitask efficiently and manage multiple tasks simultaneously, ensuring high productivity and meeting deadlines.
•  Strong comprehension and communication skills, allowing for clear understanding and effective relay of information.
•  Proficiency in computer usage, including data encoding and word-processing, to handle documentation and administrative tasks effectively.
•  Keen attention to details and the ability to take accurate notations, ensuring accuracy and precision in all work performed.
•  Capacity to handle different levels of workload, adapting to changing demands and maintaining a high level of performance.
•  Flexibility to work during holidays, weekends, and on-demand by clients to meet business needs and maintain operational efficiency.
•  Demonstrated excellence as a team player, collaborating effectively with colleagues, and being open to coaching and feedback for continuous improvement.