DE033965-Customer Service Sr Analyst

Accenture PLC; Quezon City; Hybrid; PHP 670,000 - 1,004,000; Full time

Job summary

Accenture is seeking a Customer Service Sr Analyst in Quezon City for a hybrid setup. The role involves overseeing staff performing reviews to ensure policy compliance, managing licensure, and supporting accreditation processes.

You will work with US healthcare contracts and regulatory standards, lead investigations into data breaches, and mentor team members while collaborating with Compliance and PMO teams to uphold quality and performance.

Qualifications

• 3+ years relevant experience in healthcare/compliance
• Minimum 1 year supervisory experience

Responsibilities

• Oversees staff performing reviews to ensure compliance with medical policy, eligibility, benefits, and contracts
• Maintains regulatory and accreditation compliance by interpreting and applying standards
• Ensures associates keep active licensure and reports issues to PMO and Compliance
• Facilitates accreditation activities by participating in audits as needed
• Provides leadership, mentoring, and supervision of staff
• Reports known data breaches to Compliance and conducts follow-up investigations
• Performs root cause analysis for deviations and coaching to improve performance
• Analyzes VOC trends and customer feedback to drive improvements
• Handles inbound/outbound communications with providers for data gathering
• Governs adherence to contractual regulatory expectations

Skills

Experience in healthcare/compliance

Supervisory experience

Job description

ONLY THOSE APPLICANTS WHO ALREADY HAVE THE RIGHT TO LIVE AND WORK IN THIS COUNTRY ARE ELIGIBLE TO APPLY FOR THIS ROLE

POSITION TITLE: Customer Service Sr Analyst

Work Setup: Hybrid

RESPONSIBILITIES

• Oversees staff whose primary duties may include, but are not limited to:
• Conducts pre-service, concurrent, retrospective, out of network, and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts (UM service requests are received from inbound calls and facsimile. Outbound calls to the provider may be required to gather additional information that may be needed)
• Responsible for maintaining contractual, regulatory and accreditation compliance by knowing, understanding, correctly interpreting, and accurately applying requirements, regulations and standards. Reports suspected or confirmed issues on the same day of discovery to the manager and/or the Compliance Department.
• Responsible for ensuring Associate understanding of contractual, regulatory and accreditation requirements and reporting immediately all suspected or confirmed issues or concerns to a manager and/or the Compliance Department.
• Responsible for ensuring that all clinical USRN associates maintain active, documented licensure while working in production. Removes clinical associates from production when active USRN licensure is not verified by the PMO team. Reports instances of expired or lapsed licensure on the date of discovery to the PMO team and to the Compliance Department.
• Facilitates accreditation by participating in and/or conducting audits as needed.
• Provides leadership, mentoring, and supervision of staff.
• Responsible for reporting known or suspected data breaches on the day of discovery to the Compliance Department and for conducting a follow-up investigation as needed.
• Performs Root Cause Analysis (RCA) for performance deviations and implement improvement plans and associate coaching as needed.
• Studies and analyzes VOC (Voice of customer) trends and customer feedback and work towards improving performance.

OTHERS

• Project Shift Schedule: Night Shift
• Project Rest Day: Weekends Off
• Project/Team Location: Quezon Cyberpark Tower 3

SKILL AND QUALIFICATIONS

• At least 3 years relevant experience; 1 year supervisory experience

ABOUT ACCENTURE

Accenture is a leading global professional services company that helps the world’s leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 791,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. Our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners and communities. Visit us at www.accenture.com

Equal Employment Opportunity Statement We believe that no one should be discriminated against because of their differences. All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, military veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by applicable law. Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities.

Bring your incredible skills and join our global team of innovators. We come together from different backgrounds across the world and work with the latest technologies to create value and growth for our clients. With us, you’ll continue to learn and grow so you can advance in your career. Your personal dreams and ambitions are just as important to us; that’s why we offer support any way we can—when you thrive, we all thrive. Explore your next step at Accenture Belong. Grow. Thrive. Join agreat place to work for reinventors who drive meaningful change for our clients, communities, and the world. Wo rld. Explore your next step at Accenture