PHRN - Grievance & Appeals Specialist (Hybrid)

Work Setup: Training is full onsite; once in production, 2x a week onsite (Taguig)

Start Date: Sept 15, 2026

Requirements:

• PHRN with Active license
• Must have at least 1 year grievance & case appeals experience
• Back-office (Non-voice)

Responsibilities:

• Clinical Review & Documentation: Analyzing medical records for accuracy, compliance, and appropriateness of care.
• Claims Processing: Determining patient eligibility, validating medical claims, and managing insurance coverage.
• Utilization Management: Reviewing treatment plans against medical policies to ensure cost-effective care.
• Case Management & Liaison: Communicating with healthcare providers and patients to facilitate care and resolve inquiries.