Nurse: Medical Claims Adjudication & Analytics

Applicant 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 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 ...