Job Title: Provider Dispute Resolution Analyst | NON-VOICE|
In-Office Training Now, Potential for Remote Work Later.
Position Summary:
We are seeking an experienced Provider Dispute Resolution Analyst this role is responsible for reviewing, researching, adjudicating medical claims and resolving provider disputes in compliance with regulatory guidelines and internal policies.
The ideal candidate will have hands-on experience with EZCap, a working knowledge of Medi-Cal and Commercial Insurance Claims and must have a minimum 5 years' 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.
Salary Package: Php 25,000 - Php 30,000
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.
Qualifications:
- Minimum of 5 years of experience either medical claims processing or adjudication or
- High school diploma or equivalent (associate or bachelor’s degree is a plus).
Technical Skills:
- Hands-on experience with EZCap is recommended.
- Familiarity with other EHR platforms such as Epic, Meditech, or similar is a plus.
- 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:
- Work Setup: Initially onsite in Makati City. Remote work is available post-training based on performance and business needs.
- Working Hours: Night shift; must be flexible to work holidays and weekends if required.
- Internet Requirements: A minimum of 25 Mbps download / 5 Mbps upload is required and must be hardwired.
- Work Environment: A quiet, dedicated workspace is required.
Benefits
- HMO (Medical/Dental) coverage on Day1 plus 1 FREE dependent.
- Transportation and internet allowance
- Company-provided equipment
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.
