Claims Adjudication Specialist

Connext Global Solutions is a dedicated team of business process outsourcing experts and innovators, with experience in supporting world-class companies in Title and Escrow, Healthcare, Produce Distribution, Retail and Fashion, Design Consulting, and Finance.

We are currently looking for an Claim Adjudication Specialist who will be working with Connext's Client in the United States of America.

What's in it for you

• Competitive compensation
• Perfect Attendance Bonus
• Life insurance
• HMO Insurance
• Great company culture
• Annual Merit Increase
• 25% Night Differential
• Onsite in Ortigas, Davao, Cebu, or Angeles

What is the job

The Claim Adjudication Specialist is responsible in managing the preparation, review, submission, and correction of medical claims to ensure accurate and timely reimbursement. This role works closely with providers, clinics, and internal teams to resolve denied, rejected, and coding-related claims while ensuring compliance with healthcare regulations.

• Processes medical claims, including preparation, submission, and correction of rejected, denied, and coding-related claims.

• Works rejected and denied claims within the clearinghouse and coordinates resolution with providers and clinics.

• Reviews and completes outstanding documentation to support clean claim submission.

Required Qualifications:

• Minimum of one (1) year experience in claims adjudication or medical billing within a healthcare setting.

• Experience handling Medicare, Medicaid, Tricare, and VA payers.