About this role
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
Team Lead
Oversees daily operations for all agents delivering high-quality and valued services Conduct training and coaching, including insights and action plans to improve Analyze and report on productivity and other metrics - such as attendance, end-of-day reports, and compliance with company protocols Ensure that the client is updated on significant program activities, issues, and concerns through calls, emails, meetings, reports Perform other supervisory tasks as required Claims, Denials, and EOB
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.Requirements
1 - 2 years BPO experience handling US Healthcare InsuranceAt least 6 months of team lead / supervisory experienceExperience with claims, denials, appeals, EOBExperience in Billing for a SNF (Skilled Nursing Facility) is a PLUS, not requiredStrong problem-solving skills Adaptability to a changing work environment Ability to remain calm under pressure Good verbal and written English skillsWilling to work onsite in Shaw Blvd, MandaluyongAmenable working night shiftsBenefits
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