Clinical Appeals

2 weeks ago

Makati, Philippines UnitedHealth Group Full time

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together Primary Responsibility: Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Required Qualifications: Undergraduate degree or equivalent experience Active Medical License/Physician/Medical Director 5+ years of experience in operations management or a similar role Proven track record of building and leading high-performing teams Proven solid analytical and problem-solving skills Proven excellent communication, interpersonal, and organizational skills Willing to work in US Shift and report in any of the sites Onsite work Preferred Qualification: Experience in BPO/Call Center At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone - of every race, gender, sexuality, age, location and income - deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Optum is a drug-free workplace. 2025 Optum Global Solutions (Philippines) Inc. All rights reserved. #J-18808-Ljbffr

  • Clinical Appeals Medical Doctor

    3 weeks ago

    Makati, Philippines Optum Full time

    Clinical Appeals Medical Doctor (Full time) Optum Makati, National Capital Region, Philippines Join us and be part of a company that makes healthcare data available wherever and whenever people need it, with safety and reliability. Join a culture of performance, collaboration, and opportunity; there is no room for error. Start doing your life's best work....

  • PH Registered Nurse OPAS

    2 weeks ago

    Makati, Philippines UnitedHealth Group Full time

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers,...

  • Clinical Appeals Medical Doctor

    4 days ago

    Makati City, National Capital Region, Philippines Optum Full time ₱1,500,000 - ₱4,500,000 per year

    Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Here, innovation isn't about another gadget, it's about making healthcare data available wherever and whenever people need it, safety and reliably. There's no room for error. Join us and start doing your life's best...

  • Skin Sales Consultant

    2 weeks ago

    Makati, Philippines Dempsey Resource Management Inc. Full time

    Job Opportunity: Skincare Sales & Client Specialist Salary Range: Php 25,000 – 30,000 Work Schedule: Shifting schedule, 6 days/week Locations: EDSA Shangri-La, Ortigas Center, Mandaluyong (1 vacancy) UP Town Center, Katipunan Avenue, Quezon City (1 vacancy) Key Responsibilities: Client Consultation & Sales Warmly welcome clients and build rapport to...

  • Reimbursement Manager

    2 weeks ago

    Makati, Philippines AIA Hong Kong Full time

    MediCard Phils., Inc. is one of the country's leading HMOs and the only HMO founded and run by doctors. Since its inception, the concept of service-oriented total health care has been MediCard's guiding principle. Despite the competitive landscape and tempting benefits offered by competitors, MediCard has maintained its lead by providing innovative and...

  • Reimbursement Manager

    5 days ago

    Makati, Philippines AIA Hong Kong and Macau Full time

    Reimbursement Manager page is loaded## Reimbursement Managerlocations: Makati, PH-MPItime type: Full timeposted on: Posted 30+ Days Agojob requisition id: JR-50124**MediCard Phils., Inc.** is one of the country's leading HMO and the only HMO founded and run by Doctors. Since its inception, the concept of service-oriented total health care has been the...

  • PHRN - ICU/ER Experience Required in a Tertiary Hospital | Hybrid Work Set-up!

    1 day ago

    Makati, Philippines Optum Full time

    Overview PHRN - ICU/ER Experience Required in a Tertiary Hospital | Hybrid Work Set-up. Optum Makati, National Capital Region, Philippines. Responsibilities The Clinical Appeals Nurse in Optum will ensure defensible and accurate case recommendations for concurrent admission, continued stay, and concurrent denial cases which are then reviewed by a Physician...

  • Philippine Registered Nurse

    6 days ago

    Makati City, National Capital Region, Philippines R1 RCM Full time ₱1,500,000 - ₱3,000,000 per year

    Qualifications:With active PHRN licenseAt least 1+ years of Clinical / Hospital Experience.Strong familiarity with using EMR/EHR (Electronic Medical Records or Electronic Health Records) systemsBasic Clinical Appeals writing experienceKnowledgeable with InterQual or MCG (Medical Care Guidelines) Working in an evolving healthcare setting, we use our shared...

  • Virtual Medical Biller/Coder

    2 weeks ago

    Makati, Philippines Petit Psychiatry Full time

    Psychiatry Wellness Center is looking for a Virtual Mental Health Medical Coder/Biller/Collections Specialist. We are looking for a top performer with previous experience and knowledge of billing, reimbursement, and payment posting. The Medical coder is responsible for accurately and efficiently coding medical diagnoses and procedures for a psychiatry...

  • PHRN - ICU/ER Experience Required in a Tertiary Hospital | Hybrid Work Set-up

    2 weeks ago

    Makati City, National Capital Region, Philippines Optum Full time ₱1,200,000 - ₱2,400,000 per year

    ROLE AND RESPONSIBILITIESThe Clinical Appeals Nurse in Optum will ensure defensible and accurate case recommendations for concurrent admission, continued stay, and concurrent denial cases which are then reviewed by a Physician Advisor for completion of the concurrent and/or peer to peer review. They will be working directly with the Physician Advisors...