Medical Claims Processor

xpatjobs       |    Location:null , Central Luzon       |    Country:Philippines

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 in Nursing, Pharmacy or other allied health courses as defined by the business. > Min 2 years post qualification in a relevant clinical role or medical insurance processing, approvals or customer support decision making role 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. Key Competencies > Attention to Detail > Analytical Thinking > Decision Making