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Accenture PLC is seeking a Delivery Lead Sr Manager for our Taguig, Philippines operation. This role oversees teams performing reviews and adjudication of claims to ensure compliance with medical policies, benefits, and contracts.
It requires extensive leadership over operations, strategy, and client relationships from a senior position. The Delivery Lead Sr Manager will guide cross-functional teams, drive continuous improvement, and ensure delivery excellence while managing resources,
---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
Overall Purpose: 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.
All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.
Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.
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