Medical Claims Processor
The Emirates Group
5d ago

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.

  • 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. - Applicants must be willing to work and relocate to Clark, Pampanga.- Applicants must be a Filipino citizen or have a relevant residence status-
  • 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.

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