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Clinical Decision Making Specialist

3 weeks ago

Manila, National Capital Region, Philippines Hive Health Pte Ltd Full time

Hive Health Pte Ltd is revolutionizing access to quality, affordable healthcare for millions of Filipinos. We need passionate, driven individuals to help us make it happen.

About the Job Description

This role involves optimizing our healthcare operations by reviewing, analyzing, and validating medical availments and claims. The ideal candidate will have at least 3 years of relevant clinical experience and be familiar with health coverage policies.

The responsibilities of this role include:

  • Providing clinical guidance to complex outpatient cases.
  • Reviewing and approving cases related to inpatient discharges.
  • Providing critical weekend and after-hours support.
  • Evaluating member utilization by analyzing claims data.

We value creativity, attention to detail, and problem-solving skills. If you thrive in a fast-paced environment and want to make a meaningful impact, we'd love to hear from you.