Pharmacist/ Nurse

dnata Travel Inc.; Mabalacat; On-site; PHP 279,000 - 446,000; Full time

Job summary

dnata Travel Inc. in Clark, Pampanga is looking for a Medical Claims Processor to handle e-claims from external medical providers and ensure accurate adjudication within policy and SLA; support batch reconciliation and reporting.

Applicants must hold a Bachelor’s degree in Nursing, Midwifery, or Pharmacy, with RN/Midwife/Dental Nurse/Pharmacist licensure and at least two years of hospital experience. Willingness to relocate to Clark is essential.

Qualifications

• Bachelor’s degree in nursing, midwifery, or pharmacy.
• Willing to work and relocate to Clark, Pampanga.
• Minimum 2 years hospital experience as Staff Midwife, Staff Nurse, Dental Nurse or Pharmacist.
• Registered Nurse, Midwife, Dental Nurse or Pharmacist license/certification.

Responsibilities

• Process e-claims from external medical service providers.
• Adjudicate claims accurately per policy terms and SLA.
• Review medical costs, service line items, and medical codes for appropriateness.
• Escalate claims per SOP and reconcile batches.
• Support team leader with claims reporting, analyses, and onboarding new joiners.

Skills

Willing to relocate

Professional licensure requirement

Education

Bachelor's Degree in Nursing, Midwifery or Pharmacy

Job description

Job Title: Medical Claims Processor

Minimum requirements:

• Applicants must be willing to work and relocate to Clark, Pampanga.
• With Bachelors Degree in Nursing or Midwifery or Pharmacist.
• Registered Nurse/Midwife/Dental Nurse/Pharmacist
• Minimum of 2 years hospital experience as Staff Midwife, Staff Nurse or Dental Nurse or Pharmacist

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.