To review, adjudicate and process medical e-claims received from external medical service providers according to business requirements and agreed SLA’s.
Key Responsibilities and AccountabilitiesThe 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.
Consolidating claims findings for feedback to EGHQ. - Claims reporting and utilisation trend analysis. - Adherence to agreed SOP and claims SLA’s.
Registered Nurse or Registered Allied Health Professional- Current license to practice in the Philippines- Must have 1 year of medical claims processing experience or similar.