Nurse - Medical Benefits

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 NurseMinimum of 2 years hospital experience as Staff Midwife, Staff Nurse or Dental Nurse

Key

Responsibilities and AccountabilitiesThe 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 todetermine 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.