A staffing solutions company is seeking a Coverage and Access Specialist (PHRN) to interact with insurance representatives on benefits verification. Ideal candidates must possess an active PHRN license and have strong English communication skills. Responsibilities include documenting payer interactions and managing cases throughout the patient journey. The position is based on-site in Ortigas, Pasig, with scheduled night shifts and includes a signing bonus.
Qualifications
Must have an active PHRN license.
With or without BPO experience.
Good English communication skills are essential.
Responsibilities
Interact with insurance payer representatives for benefit verifications.
Document payer interactions to inform partners on coverage status.
Manage assigned cases throughout the patient journey.
Skills
Good English communication skills
Knowledge of healthcare regulations and compliance
Education
Active PHRN license
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 or without BPO experience
Also open to PHRNs with at least 1 year in prior authorization OR eligibility, claims, and benefits (payer)
Good English communication skills
Knowledge of healthcare regulations and compliance
Start dates:
Dec. 15, 2025
Jan. 12, 2026
Jan. 19, 2026
Jan. 29, 2026 (PHRNs w/ 1 yr PA/Eligibility/Claims/Benefits exp.)
* 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