Dental Nurse
2 weeks ago
Clark Freeport Zone Pampanga, Philippines
dnata Travel Inc.
Full time
₱240,000 - ₱480,000 per year
Job Title: Medical Claims Processor
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 Degree in Nursing or Midwifery.
- Registered Nurse/Midwife/Dental Nurse
- Minimum of 2 years hospital experience as Staff Midwife, Staff Nurse or Dental Nurse
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.
