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Offshore medical claims specialists generally work in health insurance companies. Their job is to process health insurance claims and perform patient billing services for their organisation.

The role of remote-based medical claims specialists is pivotal to the financial management of both healthcare providers and health insurance companies. That’s because it’s the remuneration from medical insurance claims that provides healthcare providers with their positive cash flow. Whilst insurance companies rely on their medical claims specialists to ensure that any remuneration paid to providers is based on accurate information and covered by the patient’s policy.

Essentially, medical claims specialists ensure that health providers are paid for their services whilst patients receive the care they require.

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Role of offshore medical claims specialists

Offshore medical claims specialists play a key role in the healthcare and insurance industries. Their main responsibilities include checking and processing claims, verifying insurance policy coverage and reviewing insurance claims to prevent fraud. They also communicate with patients to answer questions about their claims status or billing issues.

To ensure that every insurance claim is complete, medical claims specialists may need to contact patients and other healthcare providers to gather additional information or confirm that specific information is correct. For example, they may check whether a pre-existing condition affects whether an insurance claim is accepted or denied.

Whilst their role includes processing routine claims, they also investigate pending claims and resolve issues with missing, incorrect or conflicting data. They also verify patient eligibility before treatments or procedures take place and apply clinical codes to facilitate reimbursement and data analysis. Remote-based medical claims specialists also need to update, edit and maintain secure databases where patient data is archived, as well as document all actions taken.

They resolve disputes, adjust claims, process appeals, negotiate claims settlements or commence the denial process for a claim. They also assemble the required documentation for insurance settlements, disputes, appeals or denials.

Skills and qualifications

Offshore medical claims specialists usually possess a Bachelor’s Degree in Healthcare Administration, Healthcare Management, Health Information Management, Health Information Technology or a related field. They also possess extensive experience in medical billing and working in the insurance claims industry.

Remote-based medical claims specialists also require several important skills, as follows.

• Excellent customer service skills.
• Strong written and oral communication skills.
• Excellent analytical and organisational skills.
• Expertise in interpreting medical terminology and abbreviations.
• Familiarity with diagnostic and treatment coding systems and procedures.
• Excellent knowledge of all relevant insurance-related policies at the local, state and federal level.
• Proficiency in negotiating insurance claims, appeals and settlements.
• High-level data entry, word processing, database management and phone skills.

Outsourcing to the Philippines

Outsourcing to the Philippines is an extremely cost-effective strategy that has gained popularity around the world. With access to a wide network of professionals in the Philippines, we provide your organisation with a shortlist of suitable offshore medical claims specialists, based on your criteria. Your dedicated medical claims specialist works full-time at our state-of-the-art facility in Manilla with all the infrastructure and resources they need to fulfil their role with your organisation, provided by Outsourced.

For more information on hiring Offshore Medical Claims Specialists in the Philippines for your business, contact Outsourced today.