Clinical Appeals Specialist | Registered Nurse | with SOB

Concentrix; Quezon City; On-site; PHP 335,000 - 536,000; Full time

Job summary

Concentrix in the Philippines is seeking a licensed PHRN to support healthcare-related customer inquiries in a fast-paced BPO environment. You will apply clinical knowledge to assist members, providers, or patients and document information accurately.

The role emphasizes strong communication, confidentiality, and collaboration with internal teams to resolve issues, with familiarity in US healthcare processes and terminology.

Qualifications

• Active Philippine Registered Nurse (PHRN) license is required.
• At least 1 year of BPO experience, healthcare account preferred.
• Strong communication and customer service skills.
• Experience in Utilization Management, Prior Authorization, Clinical Appeals, Case Management, or Healthcare Customer Service.
• Familiarity with US healthcare processes and terminology.

Responsibilities

• Handle healthcare-related inquiries from members, providers, or patients
• Review and document medical information accurately
• Provide support regarding healthcare benefits, claims, authorizations, or clinical services
• Ensure compliance with company, client, and regulatory guidelines
• Maintain confidentiality of patient information and records
• Collaborate with internal teams to resolve customer concerns in a timely manner

Skills

Communication skills

Customer service

Clinical knowledge

US healthcare knowledge

Education

Philippine Registered Nurse (PHRN) license

Job description

Support healthcare-related services as a Philippine Registered Nurse with prior BPO/Healthcare account experience. The role requires strong clinical knowledge, excellent communication skills, and experience working in a fast-paced customer service environment.

Key responsibilities

• Handle healthcare-related inquiries from members, providers, or patients
• Review and document medical information accurately
• Provide support regarding healthcare benefits, claims, authorizations, or clinical services
• Ensure compliance with company, client, and regulatory guidelines
• Maintain confidentiality of patient information and records
• Collaborate with internal teams to resolve customer concerns in a timely manner

About you

• Active Philippine Registered Nurse (PHRN) license
• At least 1 year of BPO experience, preferably in a healthcare account - Interqual OR MCG Experience
• Strong communication and customer service skills
• Experience in Utilization Management, Prior Authorization, Clinical Appeals, Case Management, or Healthcare Customer Service
• Familiarity with US healthcare processes and terminology