PHRN - Grievance & Appeals Specialist (Hybrid)
OtherAppeals Specialist
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Quick Summary
Key Responsibilities
Clinical Review & Documentation: Analyzing medical records for accuracy, compliance, and appropriateness of care. Claims Processing: Determining patient eligibility, validating medical claims,
Technical Tools
OtherAppeals Specialist
Requirements
~1 min read- PHRN with Active license
- Must have at least 1 year grievance & case appeals experience
- Back-office (Non-voice)
Responsibilities
~1 min read- →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.
Location & Eligibility
Where is the job
Taguig, Philippines
On-site at the office
Listing Details
- Posted
- September 8, 2026
- First seen
- September 28, 2026
- Last seen
- September 29, 2026
Posting Health
- Days active
- 0
- Repost count
- 0
- Trust Level
- 14%
- Scored at
- September 29, 2026
Signal breakdown
freshnesssource trustcontent trustemployer trust
External application
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