Application Deadline: 31 May 2026
Department: Operations
Employment Type: Full Time
Location: Tacloban - Himalayan, PH
Compensation: ₱45,000 - ₱50,000 / month
We’re seeking a committed Payment Integrity Supervisor to join our team and lead efforts to maximize cost-saving strategies in a TPA or insurance carrier setting. This position oversees a team responsible for claims review, vendor coordination, and implementation of cost containment programs such as bill review, for facilities and professional claims, and negotiated settlements. The supervisor ensures compliance with regulatory standards and contractual obligations while driving measurable financial outcomes.
· Supervise daily operations of the cost containment team, bill review specialists, coordinators, and vendor liaisons.
· Oversee the application of cost containment strategies such as PPO repricing, out-of-network negotiations, and clinical/utilization reviews.
· Collaborate with claims, legal, and provider relations teams to ensure consistent application of cost-saving protocols.
· Manage relationships with external vendors (e.g., bill review, CCR, and other insurance carriers as well as Stop Loss Provider) to ensure service quality and contractual compliance.
· Analyze claims data to identify trends, anomalies, and opportunities for additional savings.
· Ensure adherence to federal and state regulations, including ERISA, HIPAA, and workers’ compensation statutes.
· Develop and maintain SOPs and training materials for cost containment processes.
· 3–5 years of experience in cost containment, claims management, or healthcare finance within a TPA or insurance carrier setting.
· 1–2 years of supervisory or team leadership experience.
· Strong understanding of medical billing, coding (ICD, CPT, HCPCS), and reimbursement methodologies.
· Familiarity with claims adjudication systems and cost containment platforms.
· Excellent communication, negotiation, and analytical skills.
· Proficiency in data analysis tools (Excel, reports) and claims system
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.
