USRN Clinical Appeals and Grievances Nurses Temporary Work from Home
ACES
- Taguig City, Metro Manila
- Temporary
- Full-time
- Comprehensively review and evaluate appeal and grievance requests to identify and classify member and provider appeals.
- Determine eligibility, benefits, and prior activity related to the claims, payment or service in question.
- Responsible for coordinating with the member or authorized representative during the research process to further clarify, as needed, the member's complaint or appeal.
- Conduct thorough investigations of all member and provider correspondence by analyzing all the issues involved and obtaining responses and information from internal and external entities.
- Holder of Active USRN License from any Mainland State
- With at least 1 year clinical appeals and denials experience and 1 year utilization management experience gained from working in the BPO industry or any US healthcare company
- Willing to work on night shift - rotational weekends off
- Must be residents of Greater Metro Manila area (provincial candidates outside of Metro Manila, Laguna, Cavite, Rizal and Bulacan will not be considered)
- Work from Home
- Medical / Health Insurance
- Paid Sick Leave
- Performance Bonus
- Recruitment / Signing Bonus
- Paid Holidays
- Paid Vacation Leave
- Maternity & Paternity Leave
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