Team Leader | US Healthcare Insurance (Claims) | With 21K Signing Bonus

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 Insurance
• At least 6 months of team lead / supervisory experience

• Experience with claims, denials, appeals, EOB
• Experience in Billing for a SNF (Skilled Nursing Facility) is a PLUS, not required
• Strong problem-solving skills
• Adaptability to a changing work environment
• Ability to remain calm under pressure
• Good verbal and written English skills
• Willing to work onsite in Shaw Blvd, Mandaluyong
• Amenable working night shifts

Benefits:
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