Provider Dispute Claims Processor

Provider Dispute Claims Processor | Urgent Hiring

Work Set-Up: In-Office Training Required | Potential for Remote Work After Training

Location: Makati, Valero

Expected Start Date: TBA

Position Summary:

 We are seeking an experienced Provider Dispute Claims Processor to join our growing healthcare team. This role is responsible for reviewing, researching, adjudicating medical claims and resolving provider disputes in compliance with regulatory guidelines and internal policies. This role requires strong analytical skills, a high level of accuracy, and the ability to work independently in a fast-paced environment.

The ideal candidate must have experience either medical claims processing or provider dispute resolution, or a combination of both.

This position plays a critical role in maintaining provider satisfaction and ensuring compliance with dispute resolution timelines.

Key Duties

• Review and adjudicate provider-submitted medical claims for accuracy, completeness, and compliance with payer policies and regulatory standards.
• Investigate and resolve provider disputes related to denied, underpaid, or incorrectly processed claims
• Ensure proper application of coding standards (ICD-10, CPT, HCPCS) and billing rules.
• Identify and correct claim errors, duplicates, and mismatches in provider data.
• Process claims adjustments, reprocessing, and corrections as needed.
• Maintain detailed and accurate documentation of claim decisions and actions taken.
• Deliver 98%+ accuracy in claims adjudication while exceeding turnaround time (TAT) and quality standards, ensuring optimal service and compliance outcomes.

Qualifications:

• High school diploma or equivalent (associate or bachelor’s degree is a plus).
• Experience either in medical claims processing/ adjudication or provider dispute resolution, or combination of both is REQUIRED

Technical Skills:

• Proficient in CPT, ICD-10, and HCPCS coding validation; experienced in handling Medicare claims and secondary coverage.
• Familiarity with other EHR platforms such as Epic, Meditech, or similar is a plus.
• Experienced with platforms such as IDX and Facets.
• Strong understanding of Medi-Cal, Medicare, and commercial insurance billing and claims processes.
• Proficient in Microsoft Office Suite (Excel, Outlook, Word).

Regulatory Knowledge:

• Understanding of healthcare compliance standards, HIPAA, and payer-specific guidelines.

Core Competencies:

• Strong analytical and problem-solving skills with a high attention to detail.
• Excellent communication skills.
• Ability to manage multiple tasks, prioritize effectively, and meet strict deadlines.
• A collaborative mindset with the ability to work cross-functionally with internal teams.

Requirements & Work Arrangement:

• Amenable to work graveyard hours/night shift

• Can start ASAP. This is an urgent hiring.

• Work Arrangement: This position is currently offered on a remote work basis after successful completion of training (In-office). However, please note that this is a performance-based role, and the company reserves the right to require employees to report onsite at any time based on business needs, performance evaluations, operational requirements. Flexibility to transition to an office-based setup when necessary is expected.

Additional Benefits:

• HMO - Medical & Dental (coverage on Day1 plus 1 dependent)
• Transportation Allowance
• Equipment will be provided

COMPANY OVERVIEW:

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers.

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers.  The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually.  The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.