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Accenture is seeking a Delivery Lead Sr Manager in Taguig Uptown Bonifacio Tower 3. Work setup is return to office, with responsibilities spanning pre-service to post-service claims reviews to ensure medical necessity, benefit applicability, and contract compliance.
You will lead a team, make independent decisions, manage client relationships, drive process improvements, and align with operations managers to meet SLAs and project milestones.
---ONLY THOSE APPLICANTS WHO ALREADY HAVE THE RIGHT TO LIVE AND WORK IN THIS COUNTRY ARE ELIGIBLE TO APPLY FOR THIS ROLE---
Work Setup: Return to Office
Oversees staff whose teams’ 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. Service requests may be from inbound calls and facsimile. Outbound calls to the provider may be required to gather additional information that may be needed. Other staff responsibilities may be reviewing and analysis of post service claims utilizing the member’s benefit contract and health plan guidelines. Completes review of pending claims post service for Medical Necessity or Contractual Reviews.
Project Shift Schedule: Night Shift Project Rest Day: Weekends Off Project/Team Location: Taguig Uptown Bonifacio Tower 3
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