Job Description

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.
• Perform a comprehensive review of all medical records and reports received to ensure all component parts are completed and accurate.
• Establish coding manuals and guidelines by tailoring the read codes for use within Emirates Group Medical Services to provide a standard approach to reading and application of codes used within the department.
• Develop and review standard operating procedures to ensure consistency of practice and ensure processes are not person dependant. Train other members of the team on these procedures enabling effective cover during times of absence.

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

Job Type: Full-timeAbility to commute/relocate:

• Clark Freeport Zone, Pampanga: Reliably commute or planning to relocate before starting work (Required)