Nurse Claims Specialist – e-Claims & SLA Adjudication

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

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.