Health Operations Specialist - Pre-Authorization & Support

Accenture in the Philippines; Quezon City; On-site; PHP 279,000 - 446,000; Full time

Job summary

Accenture in the Philippines is seeking a Health Operations Associate for a return-to-office setup in Quezon City. The role involves eligibility checks, case routing, and high-volume provider communications to support clinical and administrative processes.

Ideal candidates will have a college degree or high school diploma with BPO experience, excellent English communication, and the ability to work night shifts to align with US time zones. Knowledge of medical/insurance terms is a plus.

Qualifications

• Graduate of any college degree or high school diploma with 6 months BPO experience.
• Excellent written and verbal communication skills in English.
• Willing to work night shifts and US time zones.
• Knowledge of US medical or insurance field and CPT/ICD codes is a plus.

Responsibilities

• Determines contract; verifies eligibility and benefits.
• Conducts provider radius search and follows up on referrals.
• Checks benefits for facility-based treatment.
• Obtains intake information from callers and processes requests for pre-certification and/or prior authorization.
• Performs data entry of contact into client systems and routes as appropriate.
• Matches fax/clinical records with the correct case and consolidates inputs for approval.
• Generates letters per client procedure manual.
• Assigns cases/work within the client system to meet productivity goals.
• References clinician reviews and escalates to Nurse Reviewer when needed.
• Reviews cases for completeness and correct clinical routing.
• Conducts outbound scripted calls to providers for information and approvals.

Skills

Communication skills

Customer service

Empathy

Active listening

Time management

Phone etiquette

Attention to detail

Problem solving

English proficiency

Education

High School Diploma or College Degree

Job description

Accenture in the Philippines is seeking a Health Operations Associate for a return-to-office setup in Quezon City. The role involves eligibility checks, case routing, and high-volume provider communications to support clinical and administrative processes.

Ideal candidates will have a college degree or high school diploma with BPO experience, excellent English communication, and the ability to work night shifts to align with US time zones. Knowledge of medical/insurance terms is a plus.