PHRN

Siegen HR Solutions; Manila; On-site; PHP 279,000 - 390,600; Full time

Job summary

A healthcare staffing agency is seeking a Registered Nurse in Manila to support clinical teams and manage member claims. The ideal candidate will have a BS Nursing degree and an active PHRN license, with at least three months of clinical experience. Responsibilities include assessing claims for medical appropriateness and ensuring timely payments. Experience in customer service is a plus for this role, which aims to optimize member benefits and ensure high-quality service.

Qualifications

• Minimum three (3) months of working experience as a Registered Nurse in a clinical setting.
• Direct patient care experience required.

Responsibilities

• Provide support to the clinical team to promote quality member outcomes.
• Assess medical appropriateness of claims and adjust as needed.
• Manage both new and open claims effectively.

Skills

Customer service skills

Clinical assessment

Education

BS Nursing (BSN) Degree

Active PHRN License

Job description

Responsibilities

• To provide support to the clinical team and client team to assist in the promotion of quality member outcomes, to optimize member benefits, and to promote effective use of resources. Supports the procedures that ensure adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective.
• Determine customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented.
• Assess medical appropriateness of claims submitted, and adjust claims as needed.
• Pay all covered claims accurately and timely.
• Manage both new claims and open claims equally and maintains decision turnaround times.
• Understand the client’s operations and corporate compliance, policies and procedures and best practices.

QUALIFICATIONS:

• BS Nursing (BSN) Degree
• Active PHRN License holder
• A minimum of three (3) months of prior working experience as a Registered Nurse in a clinical setting required, three months is equivalent to 480 hours of working experience as an RN
• Working experience as a Registered Nurse means holding an active RN license and providing direct patient care
• Clinical setting includes inpatient hospital, outpatient hospital or clinic
• 1 year of customer service or call-center experience and minimum of work experience is a plus