Job Title: PHRN Appeals Denials

Shift: Night shift

Work Set-up: Onsite in Bridgetowne, Quezon City

Salary range: 50,762 package (Basic:43,762 and Allowance: 7K) with signing bonus to be released on the first payout for those who can join on Dec 9th/Immediately

Target Start Date: December 9, 2025

QUALIFICATIONS:

• An active Philippine Registered Nurse (PHRN) with license required

• Minimum of 1 year of clinical nursing experience (Hospital, Clinic, or Managed Care Setting) with 6 months minimum of Clinical Process Outsourcing Experience and Background Handling Clinical Role (s) focusing on Clinical Appeals and Denials, Utilization Management and other related functions 

• With InterQual experience is a plus

• Strong clinical knowledge particularly in Medical Necessity Review and Interpretation of Clinical Documentation

• Good knowledge and understanding of different Healthcare Insurance Processes, Appeals, Grievances, and Utilization Management is preferred

• Demonstrates excellent verbal and written communication skills, strong attention to detail and case documentation practice.

• Ability to manage multiple cases and meet regulatory turnaround time under pressure

• Proficient in basic MS Office applications such as Word, Excel, and Outlook

• Willing to work on Flexible schedules including US Hours and Holidays

• Must not be a current or former employee of Concentrix

Preferred Qualifications:

• Experience handling Medicare Part C or US-based appeals cases

• Familiarity with CMS Guidelines, NCQA Standards or URAC Regulations

Experience in using Appeals Management Platforms and Salesforce Health Cloud 

PRE-SCREENING QUESTIONS:

1. How many years of experience do you have in clinical nursing (Hospital, Clinic, or Managed Care Setting)?

2. How many years of experience do you have in Clinical Appeals and Denials, Utilization Management in a CPO/BPO set up?

3. Do you have an active PHRN license?

4. Do you have InterQual process experience? If yes, please share your brief experience.

5. How much is your last drawn salary?

6. How much is your salary expectation?

7. Are you amenable to working onsite in Bridgetowne, Quezon City?

8. Do you have your TOR and Diploma?

9. This is an urgent hiring. Are you able to start on or before December 9?