USRN Clinical Appeals and Grievances Nurses Temporary Work from Home

ACES

  • Taguig City, Metro Manila
  • Temporary
  • Full-time
  • 22 days ago
  • 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.
USRN - Appeals and Grievances NursesTemporary Work from Home Set-upSalary P75,000 to P85,000Qualifications:
  • 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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