Medical Claims Examiner

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  "location": {
    "raw": "Makati, Metro Manila, 1227, Philippines",
    "city": "Makati",
    "region": "Metro Manila",
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    "id": "500",
    "isRemote": null,
    "location": {
      "city": "Makati",
      "state": "Metro Manila"
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    "departmentId": "18616",
    "locationType": "2",
    "jobOpeningName": "Medical Claims Examiner",
    "departmentLabel": "Claims Adjudication",
    "employmentStatusLabel": "Probationary (PHI)"
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  "detail_job_opening": {
    "location": {
      "city": "Makati",
      "state": "Metro Manila",
      "postalCode": "1227",
      "addressCountry": "Philippines"
    },
    "datePosted": "2026-05-29",
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    "description": "<p><span style=\"font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\"><span style=\"font-family: Inter, sans-serif; font-size: 12pt\"><span style=\"font-weight: bold\"><span style=\"font-size: 14pt\">MEDICAL CLAIMS EXAMINER - <span style=\"font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\"><span style=\"font-size: 12pt\"><span>Potential for Remote Work After Training</span></span></span></span></span></span></span><span style=\"font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\"><span style=\"font-family: Inter, sans-serif; font-size: 12pt\"><span style=\"font-weight: bold\"><br></span></span></span></p>\n<p><span style=\"font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\"><span style=\"font-family: Inter, sans-serif; font-size: 12pt\"><br></span></span></p>\n<p><span style=\"font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\"><span style=\"font-family: Inter, sans-serif; font-size: 12pt\"><br></span></span></p>\n<p><span style=\"font-size: 12pt\"><span style=\"font-weight: bold\">Work Setup:</span> In‑Office Training Required</span><br><span style=\"font-size: 12pt\"><span style=\"font-weight: bold\">Location:</span> Makati – Valero</span><br><span style=\"font-size: 12pt\"><span style=\"font-weight: bold\">Schedule:</span> Monday to Friday (Day Shift, Shifting Hours)</span><br></p>\n<p><br></p>\n<p><br></p>\n<p><span style=\"font-size: 12pt\"><span style=\"font-weight: bold\"><span>Expected Start Date: June 15, 2026</span></span></span></p>\n<p><span style=\"font-size: 12pt\"><span style=\"font-weight: bold\"><span>**only those who can start will be prioritized and processed</span></span></span></p>\n<p><br></p>\n<p><span style=\"font-weight: bold\">ImagenetLLC</span><span> </span>is a premier healthcare technology company revolutionizing<span> </span><span style=\"font-weight: bold\">medical claims processing</span><span> </span>as well as document management with unparalleled service, security, and efficiency. Our core mission is to help clients reduce costs and increase productivity by providing streamlined solutions in document imaging, data validation, adjudication, and on-demand retrieval of documents and data.</p>\n<p><br></p>\n<p><br></p>\n<p><span style=\"font-size: 14pt; font-weight: bold\">Position Summary:</span></p>\n<p><span>We are looking for <span style=\"font-weight: bold\">Medical </span></span><span style=\"font-weight: bold\">Claims Examiners</span><span> to join our rapidly growing team in Manila. In</span> this role, you will be responsible for accurately and efficiently processing medical claims in compliance with payer requirements and internal policies.</p>\n<p>Experience is <span style=\"font-weight: bold\"><em>required</em><span> </span></span>for this position.</p>\n<p><br></p>\n<p><br></p>\n<p><span style=\"font-size: 12pt; font-weight: bold\"><span style=\"font-size: 14pt; font-weight: bold\">Main Duties and Responsibilities:</span></span></p>\n<ul>\n<li>Review and<span> </span><span style=\"font-weight: bold\">adjudicate medical claims</span>, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies</li>\n<li>Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing.</li>\n<li>Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues.</li>\n<li>Review, evaluate and process all types of claims such as Encounter data, Professional and Institutional Claims for all lines of business e.g., Commercial, Point of Service (POS) Senior/Medicare, Preferred Provider Organization (PPO), Medi-Cal, etc.</li>\n<li>Ensure claims payment &amp; denial accuracy and compliance to turnaround time</li>\n<li>Participate in ongoing training and professional development activities.</li>\n<li>Maintain accurate and detailed records of claims processing activities.<br></li>\n<li>Identify and escalate complex or unusual claims for further review or investigation.<br></li>\n<li>Handle more complex claims with multiple services, providers</li>\n</ul>\n<p><br></p>\n<p><span style=\"font-size: 14pt; font-weight: bold\">Qualifications:</span></p>\n<ul>\n<li><span style=\"font-weight: bold\">2+</span><span style=\"font-weight: bold\"> years of experience</span><span> </span><span>working closely with <span style=\"font-weight: bold\">US healthcare claims</span> or in a claims processing/adjudication environment.</span></li>\n<li><span style=\"font-size: 12pt\">Understanding of health claims processing/adjudication</span></li>\n<li><span style=\"font-size: 12pt\">Medical terminology strongly preferred</span></li>\n<li><span style=\"font-size: 12pt\">Understanding of ICD-9 &amp; ICD-10</span><br></li>\n<li><span style=\"font-size: 12pt\">Ability to perform basic to intermediate mathematical computation routines</span><br></li>\n<li><span style=\"font-size: 12pt\">Basic MS office computer skills</span></li>\n<li><span style=\"font-size: 12pt\">Ability to work independently or within a team</span></li>\n<li><span style=\"font-size: 12pt\">Time management skills</span></li>\n<li><span style=\"font-size: 12pt\">Written and verbal communication skills</span></li>\n<li><span style=\"font-size: 12pt\">Attention to detail</span></li>\n<li><span style=\"font-size: 12pt\">Must be able to demonstrate sound decision-making skills</span></li>\n</ul>\n<p><span style=\"font-family: Inter, sans-serif; font-size: 12pt\"> </span></p>\n<p><span style=\"font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\">Requirements &amp; Work Arrangement: </span></p>\n<ul>\n<li><span style=\"font-size: 12pt; font-weight: bold\">Can start ASAP. This is an urgent hiring.</span><br></li>\n</ul>\n<ul>\n<li><span style=\"font-family: Inter, sans-serif; font-size: 12pt\"><span style=\"font-size: 12pt\"><span style=\"font-family: Inter, sans-serif\"><span style=\"font-weight: bold\">Work Arrangement:</span> </span>This position is currently offered on a remote work basis after <span style=\"font-weight: bold\">successful completion of training (In-office). </span>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.</span></span></li>\n</ul>\n<p><br></p>\n<p><span style=\"font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\">Additional Benefits:</span></p>\n<ul>\n<li><span style=\"font-family: Inter, sans-serif; font-size: 12pt\">Comprehensive HMO Coverage - Medical &amp; Dental </span></li>\n<li><span style=\"font-family: Inter, sans-serif; font-size: 12pt\">HMO coverage on Day 1 plus 1 dependent</span></li>\n<li><span style=\"font-size: 12pt\">Transportation Allowance</span><span style=\"font-size: 12pt\"><span style=\"font-family: Inter, sans-serif\"><br></span></span></li>\n<li><span style=\"font-size: 12pt\">Equipment will be provided</span><br></li>\n</ul>\n<p><br></p>\n<p><span style=\"font-size: 14pt\"><span style=\"font-family: Inter, sans-serif\"><span style=\"font-family: Inter, sans-serif; font-weight: bold\">Your next career move starts here – submit your application today!</span></span></span></p>\n<p><span style=\"font-size: 12pt\"><span style=\"font-family: Inter, sans-serif; font-size: 12pt\"><br></span></span></p>\n<p><br></p>\n<p><span style=\"font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\">COMPANY OVERVIEW:</span></p>\n<p><span style=\"font-family: Inter, sans-serif; font-size: 12pt\"> </span></p>\n<p><span style=\"font-family: Inter, sans-serif; font-size: 12pt\">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. </span></p>\n<p><span style=\"font-family: Inter, sans-serif; font-size: 12pt\"> </span></p>\n<p><span style=\"font-family: Inter, sans-serif; font-size: 12pt\">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.</span></p>\n<p><br></p>\n<p><span style=\"font-family: Inter, sans-serif; font-size: 12pt\">Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.</span></p>",
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    "jobOpeningName": "Medical Claims Examiner",
    "departmentLabel": "Claims Adjudication",
    "jobOpeningStatus": "Open",
    "minimumExperience": "Mid-level",
    "jobOpeningShareUrl": "https://imagenet.bamboohr.com/careers/500",
    "employmentStatusLabel": "Probationary (PHI)"
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