Job Title: PHRN – Grievance & Case Appeals

Work Setup: Hybrid – Training Fully Onsite; 2 Days/Week Onsite After Production
Work Shift: Night Shift
Employment Type: Full-Time
Experience: Minimum 1 Year in Grievance & Case Appeals.

Job Description : 

We are looking for an experienced Philippine Registered Nurse (PHRN) with an active nursing license and at least 1 year of experience handling grievances and case appeals. This is a back-office, non-voice role supporting healthcare-related case review and resolution activities.

Key Responsibilities :

1. Review and process healthcare grievances and case appeals accurately and within required timelines.

2. Analyze case details, supporting documentation, and applicable guidelines to determine appropriate resolution.

3. Ensure accurate documentation and processing of cases in accordance with operational and compliance requirements.

4. Coordinate with relevant internal teams to resolve case-related issues and support timely outcomes.

5. Maintain quality, productivity, accuracy, and turnaround-time standards while handling assigned cases.

Required Skills : 

1. Active PHRN License – Must hold an active Philippine Registered Nurse license.

2. Grievance & Appeals – Minimum 1 year of hands-on experience in grievance and case appeals.

3. Healthcare Case Review – Strong analytical and documentation skills for reviewing healthcare cases.

4. Communication & Coordination – Good written communication and ability to collaborate with internal teams.

5. Attention to Detail – Ability to manage cases accurately while meeting quality and turnaround-time requirements.

Qualifications :

• Must be a PHRN with an active license.

• Must be an Active Registered Nurse.

• Minimum 1 year of experience in grievance and case appeals.

• Experience in a back-office/non-voice environment preferred.

• Willing to work on a night shift.

• Willing to attend fully onsite training and work 2 days per week onsite after moving to production.

• Candidates with frequent job changes of less than one year are not eligible.

Important Notes : 

• Training: Fully onsite.
• Production: 2 days onsite per week.
• Shift: Night shift.