URGENT: Clinical Appeals Specialist (PHRN)

Concentrix; Quezon City; On-site; PHP 300,000 - 420,000; Full time

Job summary

Concentrix in the Philippines is seeking a Philippine Registered Nurse to join as a Clinical Appeals Specialist, combining clinical expertise with compliance and global impact.

You will review and resolve appeal cases, ensure NCQA and CMS guidelines are upheld, and communicate effectively with members and providers. A PH RN license and 1+ year nursing experience with BPO/CPO exposure are required, with US-hour flexibility. Onsite at Tera Tower, Bridgetowne, Quezon City.

Qualifications

• Active PHRN license required.
• Minimum 1 year clinical nursing experience and 6 months in BPO/CPO.

Responsibilities

• Review and resolve appeal cases with precision and compassion
• Ensure compliance with NCQA, CMS standards, and client guidelines
• Communicate effectively with members and providers
• Contribute to quality, compliance, and operational excellence in healthcare delivery
• Flexibility to work US hours and holidays

Skills

PHRN license

Clinical nursing

Communication skills

Multitasking

Documentation

Job description

Are you a Philippine Registered Nurse ready to take your career beyond the bedside? Step into a role where your clinical expertise meets innovation, compliance, and global impact.

At Concentrix, we don’t just offer jobs — we build extraordinary journeys. Join a workplace where you’ll collaborate with industry champions, sharpen your skills, and thrive in an environment filled with continuous learning, laughter, and limitless opportunities.

About the Role

As a Clinical Appeals Specialist, you’ll:

• Review and resolve appeal cases with precision and compassion
• Ensure compliance with NCQA, CMS standards, and client guidelines
• Communicate effectively with members and providers
• Contribute to quality, compliance, and operational excellence in healthcare delivery
• Active PHRN license
• At least 1 year clinical nursing experience + 6 months BPO/CPO background
• Strong knowledge of medical necessity review, appeals, and utilization management
• Excellent communication, documentation, and multitasking skills
• Flexibility to work US hours and holidays

Why Join Us?

• Collaborate with industry experts
• Access multiple learning and development opportunities
• Be part of a fun, competitive, and supportive workplace
• Work onsite at Tera Tower, Bridgetowne, Quezon City