Cost Containment Specialist
Full Time ₱28,000 - ₱35,000 / monthJob Overview
We are seeking a highly organized and detail-oriented professional to join our team as a Cost Containment Specialist. In this role, you will be responsible for screening healthcare review requests, preparing and managing case review packets, coordinating with providers and Nurse Reviewers, and ensuring the accuracy and completeness of all case materials. The ideal candidate will demonstrate strong multitasking abilities, excellent written and verbal communication skills, and a commitment to maintaining confidentiality and compliance with HIPAA regulations. A background in the health insurance industry is essential for success in this position.
Key Responsibilities
- Review and input detailed itemized bills into the claims system with a high degree of accuracy.
- Perform higher-level evaluations of claims for completeness, compliance, and correctness before final processing.
- Fully process claims from initial review to final resolution.
- Collaborate directly with nurses and clinical staff to ensure appropriate handling of complex claims.
- Support the appeals process by providing necessary documentation, claim insights, and follow-up coordination.
- Serve as a resource for escalated issues that require deeper analysis and a collaborative approach.
- Ensure strict compliance with HIPAA regulations and all applicable legal guidelines
- Perform other related duties and special projects as assigned
Skills, Knowledge & Expertise
• 2+ years of experience in the health insurance industry or a closely related field
• Strong understanding of medical insurance terminology
• 2+ years of medical claims processing knowledge
• Advanced written and verbal communication skills
• 2+ years’ experience handling and managing medical records
• Proficient in Microsoft Office Suite, including Excel, Word, and PowerPoint
• Skilled at processing information quickly and making sound decisions under pressure
• High School Diploma or GED
Skills and Abilities
• Team Collaboration
• Attention to Detail
• Multitasking
• Decision-Making
• Organization
• Multitasking
• Strong understanding of medical insurance terminology
• 2+ years of medical claims processing knowledge
• Advanced written and verbal communication skills
• 2+ years’ experience handling and managing medical records
• Proficient in Microsoft Office Suite, including Excel, Word, and PowerPoint
• Skilled at processing information quickly and making sound decisions under pressure
• High School Diploma or GED
Skills and Abilities
• Team Collaboration
• Attention to Detail
• Multitasking
• Decision-Making
• Organization
• Multitasking