Job Title: Operations Manager for Appeals – PHRN

Shift: Night Shift

Work Set-up: On-site, Bridgetowne, Quezon City

Salary Range: PHP 120,000 – 150,000

Headcount: 1

Start Date: December 31, 2025 / ASAP

Recruitment Process:

• 2 interviews with Operations (virtual)

• Assessment depending on interview recommendations

Line of Business (LOB) Description

Medical necessity review for appeals (claims denied due to medical necessity).

Job Summary

The Operations Manager for Appeals is responsible for overseeing end-to-end operations related to clinical appeals, ensuring alignment with regulatory requirements and industry standards. The role works closely with internal and external stakeholders to drive operational excellence, ensure compliance, and maintain high-quality performance outcomes.

Qualifications

• Bachelor’s Degree in Nursing with an active and valid PHRN license

• At least 1–2 years of managerial experience handling leaders (TLs/Supervisors)

• Experience managing teams handling Clinical Appeals

• Background in appeals, utilization review, or related healthcare management functions

• Strong verbal and written communication skills

• Willing to work on-site with flexible schedules, including US hours and holidays

• Must not be a current or former employee of the client’s organization

Key Responsibilities

• Oversee daily operations and ensure adherence to SLAs and regulatory standards

• Develop and implement process improvement initiatives

• Collaborate with internal teams and clients to enhance service delivery and maintain accurate staffing

• Ensure compliance with HIPAA and other regulatory requirements

Pre-Screening Questions

1. Do you have an active PHRN license?


2. How many years of experience do you have in managing teams handling Clinical Appeals (healthcare or BPO/CPO setting)?


3. How many years of managerial experience do you have?


4. Please share your years of experience handling clinical appeals and provide a brief overview of the process.


5. Do you have strong knowledge and understanding of HIPAA and other regulatory requirements?


6. What is your last drawn salary?


7. What is your expected salary?


8. Are you amenable to working on-site in Bridgetowne, Quezon City, with a night shift schedule and fixed weekends off?


9. When is your earliest possible start date once hired?