Nurse - Medical Benefits

dnata Travel Group; Morong; On-site; PHP 320,000 - 540,000; Full time

Job summary

dnata Travel Group in Clark, Pampanga is seeking a Staff Nurse/Midwife or Dental Nurse to process e-claims from external medical service providers and adjudicate them accurately according to policy terms and SLAs.

The role requires a Bachelor’s degree in Nursing or Midwifery, and at least 2 years of hospital experience in roles such as Staff Nurse, Midwife, or Dental Nurse. Filipino citizenship or valid residence status is required.

Qualifications

• Bachelor's degree in Nursing or Midwifery required.
• Filipino citizen or with valid residence status.

Responsibilities

• Process e-claims from external medical service providers.
• Perform accurate claims adjudication per policy terms and SLA.
• Review and evaluate medical costs and service line items.

Skills

E-claims processing

Claims adjudication

Education

Bachelor's Degree in Nursing or Midwifery

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 or Midwifery.
• Registered Nurse/Midwife/Dental 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.