PHRN (Prior Authorization/Eligibility & Benefits) | Kickstart your 2026!

TASQ Staffing Solutions; Pasig; On-site; Full time

Benefits offered by this job

Signing bonus

Job summary

A staffing solutions provider in the Philippines is seeking a Coverage and Access Specialist. Candidates must possess an active PHRN license and at least 1 year of BPO experience in prior authorization or claims management. Responsibilities include interacting with insurance representatives, documenting interactions accurately, and managing cases throughout the patient journey. This role is on-site in Ortigas, Pasig, with a predominantly night shift schedule and a potential signing bonus available.

Qualifications

• Must have an active PHRN license.
• At least 1 year of experience in BPO, preferably in prior authorization or claims management.
• Good English communication skills are essential.

Responsibilities

• Interact with insurance payer representatives for benefit verifications and coverage exceptions.
• Document payer interactions accurately to inform cross-functional partners.
• Manage assigned cases throughout the patient journey.

Skills

PHRN license

BPO experience

Good English communication skills

Knowledge of healthcare regulations and compliance

Ability to work independently and as part of a team

Job description

WITH SIGNING BONUS!*

Setup: On-site in Ortigas, Pasig Schedule: Shifting schedule (predominantly night shift)

Role Requirements

• Must have an active PHRN license
• With BPO experience, at least 1 year in prior authorization OR 1 year eligibility, claims, and benefits (payer)
• Good English communication skills
• Knowledge of healthcare regulations and compliance
• Ability to work independently and as part of a team
• Start date: Jan. 29, 2026

* Signing bonus - Terms and conditions apply

Responsibilities

Coverage and Access Specialist (PHRN)

• Professionally and compliantly interact with insurance payer representatives during outbound phone calls for benefit verifications (New BVs, Annual reverification BVs, and Bridge Eligibility Checks) and coverage exception follow-up calls (Prior Authorization (PAS), Non-Formulary Exceptions (NFEs,) and Appeals)
• Volume and case type to be worked to be determined by Novartis, but in collaboration with the supplier, based on current SLAs within the PSC and expected agent productivity
• Accurately and concisely document payer interactions to inform cross-functional partners on the patients' coverage status

Care Navigator (PHRN)

• Develop and maintain Subject Matter Expert (SME) level knowledge of the relevant brand and customer workstreams for the specific assigned program
• Learn and utilize protocols to respond to customer phone, chat, fax, SMS/text, mail, and e-mail inquiries, as well as other communication channels, in a prompt and courteous manner
• Professionally and compliantly interact with customers, relevant Novartis associates, and other external contacts during inbound and outbound phone calls
• Manage assigned cases throughout the patient journey; perform proper and timely escalation, tracking, triage, and follow-up where required