Health Operations Specialist: Care & Compliance

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

Job summary

Accenture PLC in Quezon City is seeking a Health Operations Associate for a night-shift, return-to-office setup. You will handle eligibility checks, provider referrals, and benefits verification, while gathering intake data and processing pre-certifications and prior authorizations.

The role involves data entry, document matching, letter generation, and case routing to support clinicians and nurse reviewers. Strong English communication and 6 months of BPO experience are preferred.

Qualifications

• 6 months BPO work experience or more
• Excellent written and verbal English communication
• Pass US CEFR B2 level or Versant score requirement for voice accounts
• Proficiency with basic computer programs
• Knowledge of utilization management and member contracts Benefitso
• Experience in United States medical/insurance field and CPT/ICD knowledge

Responsibilities

• Verify eligibility and benefits and determine contract.
• Conduct provider radius searches and follow up on referrals.
• Check benefits for facility-based treatment.
• Obtain intake information and process requests for pre-certification and/or prior authorization.
• Perform data entry and route cases in client systems.
• Match fax/clinical records to cases and consolidate inputs for approval.
• Generate letters and assign cases to appropriate queues.
• Refer cases for clinical review to a nurse reviewer as needed.
• Outbound calls to providers to obtain information and notify approvals.
• Support daily task lists and provide administrative support to clinicians.

Skills

English communication

Customer service

Empathy

Active listening

Phone etiquette

Prioritization

Caseload management

Education

College degree or high school diploma

Tools

Client systems

Job description

Accenture PLC in Quezon City is seeking a Health Operations Associate for a night-shift, return-to-office setup. You will handle eligibility checks, provider referrals, and benefits verification, while gathering intake data and processing pre-certifications and prior authorizations.

The role involves data entry, document matching, letter generation, and case routing to support clinicians and nurse reviewers. Strong English communication and 6 months of BPO experience are preferred.