Application Deadline: 31 May 2026
Department: Operations
Employment Type: Full Time
Location: Tacloban - Himalayan, PH
Compensation: ₱35,000 - ₱37,000 / month
We’re looking for an attentive and motivated Payment Integrity Claims Specialist to join our team. They will play a critical role in supporting the accuracy and integrity of claims processing and reimbursement activities. This position is ideal for a detail-oriented individual with experience in healthcare claims, itemized billing, and medical records review. The specialist will ensure compliance with plan benefits and internal policies and collaboration across teams is essential, as this role contributes to the review and final approval process of complex claims. This is an excellent opportunity to sharpen your analytical skills, deepen your knowledge of healthcare finance, and make a direct impact on ensuring accurate and efficient payments.
• Review and analyze itemized bills and medical records to validate claim accuracy and appropriateness.
• Create detailed summaries outlining how claims were processed.
• Investigate and identify billing discrepancies or potential overpayments.
• Collaborate with internal stakeholders to ensure claims align with plan design and program benefits.
• Assist with processing complex claims and denials, applying knowledge of plan benefits and cost containment strategies.
• Work within spreadsheets to compile data, track reviews, and prepare reports for final approvals.
• Support the Cost Containment/Payment Integrity team on cross-functional projects and process improvements.
• 2+ years of experience in healthcare claims processing.
• Proficiency in reading and interpreting itemized bills and medical records.
• Strong analytical and written communication skills for creating claim summaries.
• Proficiency with Microsoft Excel and other spreadsheet tools.
• Knowledge of plan benefit structures and denial codes.
• Prior experience in a payment integrity, cost containment, or health plan operations environment, preferred.
Virtual Staffing Solutions provides comprehensive outsourcing services, ranging from call center operations and back-office support to complex data processing, catering to both SMEs and large corporations in the US and UK.
Since its founding in 2018, the company has grown into a formidable force in the BPO industry, with a dedicated team of over 2,700 employees and counting. Virtual Staffing has earned a reputation for flexibility, exceptional quality, and industry-leading excellence, consistently delivering measurable success for its clients.
