Philippine Registered Nurse (PHRN) | With PHP60,000* Signing Bonus! (EH 1519)

**Get hired and receive PHP60,000 Signing Bonus! Submit your application now and receive a call within 1 to 2 working days!**

Responsibilities:

• Manages incoming or outgoing telephone calls, emails, and/or faxes, including triage, opening of cases and data entry into client system.
• Determines contract; verifies eligibility and benefits.
• Adhere to federal and state regulatory and/or client plan requirements and established workflows.
• Obtains information from claimant or other supporting systems, emails and/or from fax.
• Manages claims, collection of non-clinical information needed for review from claimants and providers, utilizing scripts to screen basic and complex requests.
• Data entry of contact into client systems and route as appropriate.
• Tasks cases accurately to the correct queue.
• Performs leave follow-ups as required, including recertification of health conditions, intermittent claim tracking, Return to Work confirmation, etc.
• Update systems to accurately reflect leave status and ensure appropriate documentation exists.
• Conducts outbound scripted calls to claimants and providers to request for clinical information.
• Review and assessment of primarily complex illness and injury claims.
• Identify restrictions and limitations based on physiological, psychological, and social factors to assist claim management staff in their claim handling activities.
• Validate the medical necessity of limitations and/or restrictions with clear rationale.
• Provide claim management staff with medical insight and education to assist them in determining appropriate determination.
• Discuss medical issues and documents outcomes of discussions.
• Uses available resources to understand contractual and regulatory compliance requirements and reports suspected compliance issues on the day of discovery to a Team Lead, Manager, and/or the Compliance Department.
• Responsible for reporting known or suspected data disclosures or fraud on the day of discovery to a Team Lead.

Qualifications:

• Graduate of Bachelor’s Degree in Nursing
• Holds active and unrestricted local (PH) Registered Nurse license
• Must have at least 3 months experience as a Registered Nurse in a clinical setting
• Experience in a front-office (voice) call center or BPO back-office environment is an advantage
• Knowledge of ICD-9 and ICD-10 and CPT codes is an advantage
• Must be amenable to work in Cubao, Eastwood, Mandaluyong, and other possible Accenture sites in Metro Manila

Skills Requirement:

• Communication Skills
• Professionalism Skills
• Clinical Information Systems
• Customer Service

Benefits:

• Competitive salary package, company bonuses, and performance incentives
• Night differential
• Loyalty, Christmas gift, Inclusion and diversity benefits
• Paid sick and vacation leaves
• Expanded maternity leave up to 120 days*
• HMO coverage (medical and dental) from day 1 of employment
• Life insurance
• Employee stock purchase plan
• Retirement plan
• Flexible working arrangements
• Accessible locations
• Healthy and encouraging work environment
• Career growth and promotion opportunities