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.

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