iSTA SolutionsClaims Specialist
ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Claims Specialist to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly skilled professionals, who prioritize employee satisfaction and work-life balance. At ISTA Solutions, we pride ourselves on creating a culture focused on long-term success and life-long learning. We're looking for a team player who is ready to contribute to our mission, just like you!
Account specific roles and responsibilities
Insurance Eligibility Verification (EOB Review)
Verify residents’ insurance coverage using systems such as Waystar and PointClickCare.
Review and confirm insurance types including Medicare, Medicaid, HMO, and other payers.
Determine which services are eligible for billing and reimbursement based on coverage.
Review claims that have been denied due to provider-related issues.
Identify and document the reason for denial based on payer feedback or system records.
Escalate findings and required corrections to the onshore team for follow-up with providers.
Track denied claims and monitor status until the necessary information is received for resubmission.
At least 6 months BPO experience handling US Healthcare Insurance
Experience with claims, denials, appeals, EOB
Experience in Billing for a SNF (Skilled Nursing Facility) is a PLUS, not required
Strong problem-solving skills
Adaptability to a changing work environment
Ability to remain calm under pressure
Good verbal and written English skills
Willing to work onsite in Shaw Blvd, Mandaluyong
Amenable working night shifts
What can we offer you?
- Competitive salary and benefits
- Health Insurance with free dependents*
- 10%-night differential
- Attendance Bonus
- Paid time off
- Convertible to cash leave credits
- Performance Appraisal
- Work-life balance
- A focus on growing your career path with us
- We encourage you to follow your passions and learn new skills
Our commitment to you
- Strong culture and values-driven leadership
- We create opportunities for you to learn and grow at any stage of your career
- Continuous learning and innovation
- We foster an all inclusive environment where everyone thrives