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Duties and Responsibilities:
Manages incoming or outgoing telephone calls, emails, and/or faxes, including triage, opening of cases and data entry into client system.Determines contract; verifies eligibility and benefits.Adhere to federal and state regulatory and/or client plan requirements and established workflows.Obtains information from claimant or other supporting systems, emails and/or from fax. Manages claims, collection of non-clinical information needed for review from claimants and providers, utilizing s
cripts to screen basic and complex requests.Data entry of co
ntact into client systems and route as appropriate.Tasks cases accurately to the correct queue.Performs leave follow-ups as required, including recertification of health conditions, intermittent claim tracking, Return to Work /con
firm/iation, etc.Updat
e systems to accurately reflect leave status and ensure appropriate docu
mentation exists.Co
nducts outbound s
cripted calls to claimants and providers to request for clinical information.Review and assessment of primarily complex illness and injury claims.Identify restrictions and limitations ba
sed on physiological, psychological, and social factors to assist claim management staff in their claim handling activities.Validate the medical necessity of limitations and/or restrictions with clear rationale.Provide claim management staff with medical insight and education to assist them in determining appropriate determination.Discuss medical issues and docu
ments outcomes of discussions.Uses available resources to understand co
ntractual and regulatory compliance requirements and reports suspected compliance issues on the day of discovery to a Team Lead, Manager, and/or the Compliance Department.Respo
nsible for reporting known or suspected data disclosures or fraud on the day of discovery to a Team Lead.
Qualifications:
Graduate of Bachelor’s Degree in NursingHolds active and unrestricted local (PH) Registered Nurse licenseMust have at least 3 mo
nths experience as a Registered Nurse in a clinical settingExperience in a front-office (voice) call center or BPO back-office enviro
nment is an advantageKnowledge of ICD-9 and ICD-10 and CPT codes is an advantageMust be amenable to work in Cubao, Eastwood, Mandaluyong, and other possible Accenture sites in Metro Manila
How to apply?
Apply in Jobstreet
Click on “Apply Now” to submit your application and upload your updated resume.In adherence to Accenture's process of Identity Verification, your resume or CV must include your photo to ensure the accuracy of your application and your during interviews, a snapshot of your image will be captured for the same purpose.For faster processing of your application, please make sure to have your latest NBI clearance ready. For successful candidates who worked with previous employers, please prepare your approved resignation letter, SSS employment history and Statement of Account. Your recruiters will also remind you of other requirements you can prepare ahead of time.
Why join Accenture?
Competitive salary package, company bonuses, and performance incentivesNight differentialLoyalty, Christmas gift, Inclusion and diversity benefitsPaid sick and vacation leavesExpanded maternity leave up to 120 days*HMO coverage (medical and dental) from day 1 of employmentLife insuranceEmployee stock purchase planRetirement planFlexible working arrangementsAccessible locatio
nsHealthy and encouraging work enviro
nmentCareer growth and promotion opportunities
*Terms and conditions apply
Accenture is a global professional services company with leading capabilities in digital, cloud and security. Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Interactive, Technology and Operations services—all powered by the world’s largest network of Advanced Technology and Intelligent Operations centers.Our 514,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.Visit us at www.accenture.com.Accenture Career Centers* *currently not accepting walk-in applicantsManila 4F Gateway Tower 2, General Malvar Street, Cubao, Quezon CityMonday to Friday, 9:00 AM to 7:00 PM3F Forum Robinsons Mall, Pioneer Street corner EDSA, Mandaluyong CityMonday to Friday, 8:00 AM to 7:00 PMGF Plaza B Building, Northgate Avenue, North Cyberzone, Filinvest Alabang, Muntinlupa Monday to Friday, 9:00 AM to 5:00 PMIlocos Valdez Building A, Venvi IT Hub, Barangay 1, San Nicolas, Ilocos NorteMonday to Friday, 9:00 AM to 6:00 PMCebu16F Ebloc2, Geonzon Street, Cebu IT Park, Cebu CityMonday to Friday, 9:00 AM to 4:00 PM Stay connected Facebook.com/accenturejobsph Twitter.com/accenturejobsph Youtube.com/accenturejobsph Instagram: @accentureph LinkedIn Showcase Page: Accenture Careers in the PhilippinesReady to join us? Upload your updated CV to Jobstreet, then click “APPLY NOW.” If you need special assistance because of a disability, please let us know via email at careersPH@accenture.com (Please do not send any CV to this email)Accenture is an equal-opportunity employer. All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law. Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process. Accenture is committed to providing veteran employment opportunities to our service men and women.