Usrn Clinical Appeals And Grievances Nurses Temporary Work From Home  

• Comprehensively review and evaluate appeal and grievance requests to identify and classify member and provider appeals.
• Determine eligibility, benefits, and prior activity related to the claims, payment or service in question.
• Responsible for coordinating with the member or authorized representative during the research process to further clarify, as needed, the member's complaint or appeal.
• Conduct thorough investigations of all member and provider correspondence by analyzing all the issues involved and obtaining responses and information from internal and external entities.

USRN - Appeals and Grievances Nurses

Temporary Work from Home Set-up

Salary P75,000 to P85,000

Qualifications:

• Holder of Active USRN License from any Mainland State
• With at least 1 year clinical appeals and denials experience and 1 year utilization management experience gained from working in the BPO industry or any US healthcare company
• Willing to work on night shift - rotational weekends off
• Must be residents of Greater Metro Manila area (provincial candidates outside of Metro Manila, Laguna, Cavite, Rizal and Bulacan will not be considered)