BestJobs - Jobs - Medical Claims Processor - Non Voice

    Description



  • 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

    Registered Nurse or Registered Allied Health Professional

    Current license to practice in the Philippines

    Must have 1 year of medical claims processing experience or similar.

    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.

  • Requirements

  • Minimum education level: Bachelor´s Degree
  • Years of experience: 2
  • Language(s): Tagalog ,English
  • Availability for travel: No
  • Availability for change of residence: No

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Job summary

  • Medical Claims Processor

  • Pampanga, Central Luzon

  • Company

    dnata Travel Inc.
  • Work type

    Permanent contract

  • Apply