Pharmacist / Nurse - Medical Benefits

2 days ago

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

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/Pharmacist
  • Minimum of 2 years hospital experience as Staff Midwife, Staff Nurse or Dental Nurse or Pharmacist

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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