job description
Join Imagenet Phils., Inc. as a Claims Operations Supervisor and lead a high-performing team in processing U.S. healthcare claims with precision and efficiency. This remote role based in Bali, Indonesia offers the opportunity to oversee end-to-end claims operations, ensuring compliance with U.S. healthcare regulations while driving operational excellence.
As a key leader in our global operations, you will collaborate with cross-functional teams to streamline workflows, resolve complex claims issues, and implement best practices to enhance accuracy and turnaround times. Your expertise in U.S. healthcare claims processing and team management will be instrumental in maintaining our reputation for service excellence.
We offer a competitive salary, flexible remote work arrangements, and a dynamic environment where your contributions directly impact our success. If you are a results-driven professional with a passion for healthcare operations, we invite you to apply and take the next step in your career.
Responsibility
- Supervise and mentor a team of claims processors to ensure accurate and timely adjudication of U.S. healthcare claims.
- Monitor team performance metrics, including productivity, accuracy, and turnaround times, and implement improvements as needed.
- Review and resolve escalated or complex claims, ensuring compliance with U.S. healthcare regulations (e.g., HIPAA, CMS guidelines).
- Develop and maintain standard operating procedures (SOPs) for claims processing to enhance efficiency and consistency.
- Collaborate with internal stakeholders (e.g., Quality Assurance, Training, IT) to address systemic issues and optimize workflows.
- Conduct regular audits of processed claims to identify errors, trends, or training opportunities.
- Prepare and present performance reports to senior management, highlighting key insights and recommendations.
- Stay updated on changes in U.S. healthcare policies and payer requirements, and adapt processes accordingly.
Qualifications
- Bachelor’s degree in Healthcare Administration, Business, or a related field; equivalent experience may be considered.
- Minimum 5 years of experience in U.S. healthcare claims processing, with at least 2 years in a supervisory role.
- In-depth knowledge of medical coding (ICD-10, CPT, HCPCS) and claims adjudication guidelines.
- Proven ability to lead and develop teams in a remote or hybrid work environment.
- Strong analytical skills with experience using claims management software (e.g., Facets, Epic, or proprietary systems).
- Excellent communication skills (written and verbal) with the ability to explain complex claims issues to non-technical stakeholders.
- Certification such as Certified Professional Coder (CPC) or Certified Healthcare Access Associate (CHAA) is a plus.
- Familiarity with U.S. payer systems (e.g., Medicare, Medicaid, commercial insurers) and denial management.