Medical Claims Processor - Nurse

dnata Travel Inc.; Mabalacat; On-site; PHP 250,000 - 380,000; Full time

Job summary

dnata Travel Inc. is seeking a dedicated Nurse Claims Processor to handle medical e-claims from external providers. The role requires meticulous adjudication following policy terms and SLAs, with strong attention to cost review and documentation.

You will relocate to Clark, Pampanga, join a collaborative team, and support senior staff with reporting, trend analysis, and training new joiners, ensuring adherence to SOPs.

Qualifications

• Bachelor's degree in Nursing required.
• Registered Nurse or Dental Nurse registered.
• Minimum 2 years hospital experience as Staff Nurse or Dental Nurse.

Responsibilities

• Process e-claims from external medical service providers.
• Adjudicate claims accurately per policy terms and SLA.
• Review medical costs and service line items.
• Review medical codes, supporting documents to determine medical appropriateness.
• Escalate claims per SOP and perform batch reconciliation and closing.
• Support team leader with consolidating findings, reporting, and training.

Skills

Claims adjudication

SOP compliance

Cost review

Documentation

Education

Bachelor's Degree in Nursing

Job description

Minimum requirements:

• Applicants must be willing to work and relocate to Clark, Pampanga.

• With Bachelors Degree in Nursing.

• Registered Nurse/Dental Nurse

• Minimum of 2 years hospital experience as 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.