Medical Claims Processor

1 week ago

Clark Freeport and Special Economic Zone Central Luzon, Philippines dnata Travel Group Full time ₱900,000 - ₱1,200,000 per year

dnata is the largest travel management organisation in the Middle East, with over 50 years of experience in the industry. Over the years, we have established successful partnerships with a range of first-class service providers, in order to offer you the best travel products in the world. Our Services range from Retail, Business, and Airline General Sales Agent Services and Destination Management.

Job Purpose:

To review, adjudicate and process medical e-claims received from external medical service providers according to business requirements and agreed SLA's.

Minimum requirements:

  • Applicants must be willing to work and relocate to Clark, Pampanga.
  • Applicants must be a Filipino citizen or have a relevant residence status.
  • With Bachelors in Nursing or other allied health courses as defined by the business.
  • Min 2 years post qualification in a relevant clinical role or medical insurance processing, approvals or customer support decision making role

Key Responsibilities and Accountabilities

  • The job holder's primary task will be to process e-claims received from external medical service providers. This involves:
  • Accurate claims adjudication as per policy terms and conditions.
  • Accurate claims adjudication as per agreed business SOP and within agreed SLA's.
  • Review and evaluation of medical costs and service line items.
  • Review and evaluation of medical codes, supporting documents and observations to
  • determine medical appropriateness.
  • Correct escalation of claims as per agreed SOP.
  • Batch reconciliation and closing.

The job holder will also be responsible for supporting the team leader with the following tasks, as required:

  • Consolidating claims findings for feedback to EGHQ.
  • Claims reporting and utilisation trend analysis.
  • Adherence to agreed SOP and claims SLA's.
  • New joiner support and buddy training.

  • Medical Benefits

    1 week ago

    Clark Freeport and Special Economic Zone, Central Luzon, Philippines dnata Travel Group Full time ₱300,000 - ₱600,000 per year

    dnata is the largest travel management organisation in the Middle East, with over 50 years of experience in the industry. Over the years, we have established successful partnerships with a range of first-class service providers, in order to offer you the best travel products in the world. Our Services range from Retail, Business, and Airline General Sales...

  • Medical Doctor

    5 days ago

    Clark Freeport and Special Economic Zone, Central Luzon, Philippines dnata Travel Group Full time ₱30,000 - ₱1,200,000 per year

    dnata is the largest travel management organisation in the Middle East, with over 50 years of experience in the industry. Over the years, we have established successful partnerships with a range of first-class service providers, in order to offer you the best travel products in the world. Our Services range from Retail, Business, and Airline General Sales...

  • Pharmacist / Nurse - Medical Benefits

    5 days ago

    Clark Freeport Zone, Pampanga, Philippines dnata Travel Inc. Full time

    Job Title: Medical Claims ProcessorMinimum requirements:Applicants must be willing to work and relocate to Clark, Pampanga.Applicants must be a Filipino citizen or have a relevant residence status.With Bachelors Degree in Nursing or Midwifery.Registered Nurse/Midwife/Dental Nurse/PharmacistMinimum of 2 years hospital experience as Staff Midwife, Staff Nurse...

  • Medical VA

    21 hours ago

    Baliuag, Central Luzon, Philippines Global Medical Virtual Assistants Full time $32,000 - $40,000 per year

    A medical virtual assistant works closely with medical professionals or health insurance companies to ensure that the best interests of the healthcare provider, patient, and medical establishment are met.TASKS:Managing inbound calls from and outbound calls to patients, providers, and healthcare insurance companies regarding inquiries, appointments, and data...

  • Medical Doctor

    4 days ago

    Clark Freeport Zone, Pampanga, Philippines dnata Travel Inc. Full time

    Job Purpose:The Pre-Approval Officer - Medical Benefits will work within the Medical Benefits team and will be responsible for issuance of pre-approvals to medical providers for specific services mentioned in the contractual SOP. The role holder will manage telephone and system approvals and be responsible for confirming cover based on member's eligibility,...

  • Supervisor, Contact Center

    6 days ago

    Clark Freeport and Special Economic Zone, Central Luzon, Philippines Ventra Health Full time ₱600,000 - ₱1,200,000 per year

    Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve...

  • Contact Center Specialist

    5 days ago

    Clark Freeport and Special Economic Zone, Central Luzon, Philippines Ventra Health Full time ₱250,000 - ₱500,000 per year

    Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve...

  • Medical Billing Team Lead

    5 days ago

    Clark Freeport Zone, Philippines Shore360, Inc Full time

    Revenue Cycle Team LeadRoles and ResponsibilitiesManage and monitor daily team performance to ensure productivity and accuracy in billing operations.Provide daily guidance, coaching, and support to team members based on performance reviews.Prepare, review, and transmit clinical charges, including updating procedure and diagnosis codes in computer...

  • Medical Claims and Referrals Specialist

    5 days ago

    San Juan Central Post Office P, Philippines COMP Management, Inc. Full time

    Location: San Juan City, Philippines (On-Site Only)Job Type: Full-time, Night ShiftExperience Level: Entry to Mid-Level (1+ years experience preferred)The OpportunityWe are seeking a highly organized, detail-oriented, and customer-focused Medical Claims and Referrals Specialist to join our essential support team in San Juan City.In this role, you will play a...

  • Medical Billing Team Lead

    5 days ago

    Clark Freeport Zone, Pampanga, Philippines JOBS360 Full time

    Revenue Cycle Team LeadRoles and ResponsibilitiesManage and monitor daily team performance to ensure productivity and accuracy in billing operations.Provide daily guidance, coaching, and support to team members based on performance reviews.Prepare, review, and transmit clinical charges, including updating procedure and diagnosis codes in computer...