Clinical Claims Representative

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Responsible for researching and investigating other coverage for all of the company's groups and members.Performs multi complex functions and interprets complex rules, laws and contracts.Accountable for end-to-end functionality on every Coordination of Benefits (COB) function including reconciliation of claim, membership and accounting. Primary duties may include, but are not limited to: Utilizes internal queries, internal resource tools, must initiate delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS and Medicaid and report to identify members who are or should be enrolled in other coverage. Aides members in enrolling in Medicare when they are entitled.Updates all of the company's membership system components with investigation results for claim coordination. Ensures correct forms are provided to assist members enrolling in Medicare.Reviews claim history to reconcile processed, pended or recovered in any error.Associate must identify the correct formulas in order to adjudicates impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines.

Qualifications:

1 year of Healthcare experience, claims processing and/or customer service skills1 year coordination of benefits experience; or any combination of education and experience, which would provide an equivalent background.Requires knowledge of NAIC & CMS COB guidelines; excellent oral and written communication skills and skill in using PC, database system, and related software (word processing, spreadsheets, etc.).

To expedite the process of your application, please have your government numbers / ID ready (SSS, TIN, Philhealth, Pagibig), and NBI Clearance. For candidates applying for Clinical Operations, please also have your PRC and/or USRN license numbers / IDs ready.

Questions? Chat with us via Facebook Messenger at m.me/LegatoHealthPH​ or send an SMS at 0917-6LEGATO

Legato Health Technologies Philippines (Anthem's Global In-House Center) is an independent health services provider, committed to transforming healthcare management services. Our purpose is to establish quality healthcare experience and to create greater access to care through innovation. We provide efficient and appropriate solutions to meet the needs of our customers, leveraging our key sources to deliver outstanding services. Legato Health Technologies Philippines is a place for skilled and compassionate individuals, who share our goal to make a difference. We apply service excellence through handling inquiries and medical concerns. We provide Call Center, Clinical, and Applied Health IT services, led by our seasoned and visionary leadership team who is dedicated to outstanding customer service. Our work environment reflects the services we provide. We champion collaboration and innovation to drive our employees to deliver the best care.