Clinical Appeals & Grievance Specialist

Accenture in the Philippines; Taguig; On-site; PHP 300,000 - 540,000; Full time

Job summary

Accenture in the Philippines is seeking a Health Clinical Svcs Specialist to manage grievance and appeal workflows, prepare complete records, and craft detailed case narratives for regional review.

The role requires a BSN/GN/BSN-equivalent, an active US RN license, and a minimum of 3 months clinical experience providing direct patient care in inpatient or outpatient settings. Rotation shifts in Taguig Uptown are included.

Qualifications

• Active US RN license is required.
• Minimum 3 months of clinical experience (480 hours) as an RN.
• Experience in direct patient care in inpatient/outpatient settings.
• Supervisory experience is a plus and flexibility to support Appeals.
• Open to candidates without UM experience if they have Appeals exposure.

Responsibilities

• Grievance and Appeals processing.
• Create complete appeal records using standardized forms.
• Generate detailed case summaries in narrative format for each appeal.
• Submit cases for regional review as directed.
• Present verbal and written summaries to the client Grievance Team and Medical Directors.
• Meet client turnaround times.
• Conduct written communication assessments.
• Rotation Project/Team location: Taguig Uptown Bonifacio Tower 3.

Skills

US RN license

Clinical experience

Direct patient care

Supervisory experience

UM experience

Appeals experience

Education

BSN/GN Diploma/BSc in Nursing

Nursing Diploma

Tools

None

Job description

Accenture in the Philippines is seeking a Health Clinical Svcs Specialist to manage grievance and appeal workflows, prepare complete records, and craft detailed case narratives for regional review.

The role requires a BSN/GN/BSN-equivalent, an active US RN license, and a minimum of 3 months clinical experience providing direct patient care in inpatient or outpatient settings. Rotation shifts in Taguig Uptown are included.