Care Management Analyst | PHRN

Accenture Philippines

  • Mandaluyong, Philippines
    Robinsons Cybergate Towers 1, 2 and 3, EDSA cor. Pioneer Street, Mandaluyong City, Manila, 1554 Metro Manila, Mandaluyong, Metro Manila, Philippines
    Metro Manila
  • Full time
Recruiter was hiring 3 days ago

Job Description

To provide support to the clinical team and client team to assist in the promotion of quality member outcomes, to optimize member benefits, and to promote effective use of resources. Supports the procedures that ensure adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective.

  • Determine customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented.
  • Assess medical appropriateness of claims submitted, and adjust claims as needed.
  • Pay all covered claims accurately and timely.
  • Manage both new claims and open claims equally and maintains decision turnaround times.
  • Understand the client’s operations and corporate compliance, policies and procedures and best practices.

35K Signing Bonus!
Terms and Condition Apply

Minimum Qualifications

  • BS Nursing (BSN) Degree
  • Active PH RN License holder
  • A minimum of three (3) months of prior working experience as a Registered Nurse in a clinical setting required
  • Three months is equivalent to 480 hours of working experience as an RN
  • Working experience as a Registered Nurse means holding an active RN license and providing direct patient care
  • Clinical setting includes inpatient hospital, outpatient hospital or clinic
  • year of customer service or call-center experience and a minimum of work experience is a plus

Jobs Summary

Job level
Associate / Supervisor
Job category
Health and Medical
Educational requirement
Bachelor's degree graduate
Recruiter response to application
Office Address
Robinsons Cybergate Towers 1, 2 and 3, EDSA cor. Pioneer Street, Mandaluyong City, Manila, 1554 Metro Manila
Information Technology / IT
1 opening

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About Accenture Philippines

Accenture is a leading global professional services company, providing a broad range of services and solutions in strategy, consulting, digital, technology and operations. We help organizations maximize their performance and achieve their vision. We develop and implement technology solutions to improve our clients’ productivity and efficiency — and may run parts of their operations on their behalf. Ultimately, we enable our clients to become high-performance businesses and governments. With approximately 442,000 people serving clients in more than 120 countries, Accenture drives innovation to improve the way the world works and lives.
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