Medical Nurse - Claims Processor ( Non-voice)

Job Title: Medical Claims Processor

Minimum requirements:

• 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.
• New joiner support and buddy training.