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Healthcare Associates (For Pooling)

1 Year or Less

With business certificates

Established in 1989
5001-10,000 Employees

6F EBloc 2 Bldg, W Geonzon St, IT Park, Apas, Cebu City, Cebu

Posted On: April 13, 2021

Job ID: 376450

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Company Description
 
Accenture in the Philippines is a pioneer in Accentures global delivery network. Over the past 30 years, we have expanded our capabilities to become a powerhouse company providing end-to-end technology and business services. As part of Accentures global footprint in over 120 countries, covering 40-plus industries, we have been working with the biggest companies in the country and around the globe.
 
Innovation, a constant at Accenture, enables us to find new ways to stay ahead of our clients challenges. Our inclusive, diverse and strong culture of equality helps us constantly drive innovation in the workplace. By combining our industry expertise and the deep skills of our people with the latest technologies and our uncompromising high-performance standards, we help organizations grow their business and succeed in the digital age.
 
HEALTHCARE ASSOCIATES (FOR POOLING)
 
Qualifications:
  • Bachelor’s degree graduate of Nursing or any health-related courses
  • At least 6 months CSR experience preferably with a life insurance account
  • Excellent English skills in both verbal and written
  • Willing to work on holidays, weekends, shifting schedules and extended working hours
Responsibilities:
  • Providing support to the claim managers and client team in the promotion of quality claimant outcomes, to optimize claimant benefits, and to promote effective use of resources.
  • Supporting the procedures that ensure adherence to policies and claimant benefits in providing service that is appropriate, high quality, and cost effective.
  • Managing incoming or outgoing telephone calls, emails, and/or faxes, including triage, opening of cases and data entry into client system
  • Determining contract; verifies eligibility and benefits.
  • Adhering to federal and state regulatory and/or client plan requirements and established workflows
  • Obtaining 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 scripts to screen basic and complex requests.
  • Maintaining and updating systems to accurately reflect leave status and ensure appropriate documentation exists.
  • Conducts outbound scripted calls to claimants and providers to request for clinical information.
  • Identifying restrictions and limitations based on physiological, psychological, and social factors to assist claim management staff in their claim handling activities, validating the medical necessity of limitations and/or restrictions with clear rationale, providing claim management staff with medical insight and education to assist them in determining appropriate determination, and discussing medical issues and documents outcomes of discussions.
  • Ensuring team compliance to client requirements and reports suspected compliance issues to the compliance department.

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