Job Description

Accenture in the Philippines is currently looking for talented individuals for our Health Services Senior Manager (USRN).

About the Role: As a Health Services Senior Manager (USRN), you will be performing the following tasks on a daily:

• Conducts pre-service, concurrent, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. 
• Service requests may be from inbound calls and facsimile. 
• Outbound calls to the provider may be required to gather additional information that may be needed.
• Other staff responsibilities may be review and analysis of post service claims utilizing the member’s benefit contract and health plan guidelines.
• Completes review of pending claims post service for either Medical Necessity or Contractual Reviews.

About You: The ideal candidate will have the following skills and experience:

• At least 12 years relevant experience and 10 years supervisory
• Holds current and unrestricted US Registered Nurse license. No state specific RN licensure required.
• BPO experience should be any account (Health account experience is only a plus, but not required)
• Amenable to work in Uptown, Taguig City

Note: If you're interested, please apply through this job ad. You’ll be directed to complete a form or receive an email with instructions. Make sure to submit all required info within 24 hours to process your application.

What’s in it for you? Start your Accenture journey to enjoy these benefits:

• HMO coverage (medical, dental, mental health) from day 1 of employment
• Free medicines for you and your dependents*
• Expanded maternity leave up to 120 days*
• Expanded paternity leave up to 30 days*
• Employee Stock Purchase Plan
• Paid Sick and Vacation Leaves
• Allowances, company bonuses, and performance incentives
• Loyalty and Christmas Gift
• Inclusion and Diversity Benefits
• Flexible working arrangements
• Company-sponsored trainings like upskilling and certification
• Volunteering opportunities

*Terms and conditions apply

Qualification Required

• College Graduate