Medical Nurse - Claims Processor ( Non-voice)

dnata Travel Group; Philippines; On-site; PHP 335,000 - 614,000; Full time

Job summary

dnata Travel Group in Clark, Pampanga seeks a Registered Nurse to join our medical claims team. The role focuses on processing e-claims from external providers, ensuring accurate adjudication and cost review.

Applicants must have a Bachelor's in Nursing, be a licensed RN, and have at least 2 years hospital experience (Staff Nurse, Midwife or Dental Nurse). On-site role requiring relocation to Clark, Philippines.

Qualifications

• Bachelor's degree in Nursing required.
• Registered Nurse with valid license.

Responsibilities

• Process e-claims from external medical providers.
• Adjudicate claims accurately per policy and SOP.
• Review medical costs and service line items.
• Review medical codes and supporting documents to determine appropriateness.
• Escalate claims per SOP and ensure batch reconciliation.

Skills

Claims processing

Adjudication

Medical cost review

Medical coding review

SOP compliance

Education

Bachelor's Degree in Nursing

Job description

• 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.
• Registered 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.