Clinical Appeals Specialist

16 hours ago

Quezon City, National Capital Region, Philippines Pinnacle Intelligence Full time ₱50,000 per year

We are seeking highly qualified professionals to join our team as Clinical Appeals Specialists (PHRNs). This role offers competitive compensation, bonuses, and the opportunity to work onsite in Quezon City.

Role Summary

We are looking to hire 10 Clinical Appeals Specialists (PHRNs) with an onboarding date of September 2, 2025. Candidates must complete all screening processes and be available to start on the given date.

What We Offer

· Sign-On Bonus: PHP 50,000 (paid in the 3rd and 6th month)

· Salary Package: Competitive

· Work Setup: Onsite at Bridgetowne, Quezon City

· Schedule: Shifting schedule

Required Qualifications

· An active Philippine Registered Nurse (PHRN) license is required.

· At least 1 year of clinical nursing experience (hospital, clinic, or managed care setting).

· A minimum of 6 months of Clinical Process Outsourcing experience (particularly in Medical Necessity Review and Interpretation of Clinical Documentation).

· Good knowledge and understanding of different Healthcare Insurance Processes, Appeals, Grievances, and Utilization Management.

· Willingness to work onsite at Bridgetowne, QC, and openness to a shifting schedule.

Application Process

Interested candidates should submit their application and credentials as soon as possible. Please ensure you are available to start by September 2, 2025.

Job Type: Full-time

Benefits:

  • Paid training

Work Location: In person

  • Clinical Appeal Specialist

    16 hours ago

    Quezon City, National Capital Region, Philippines ECLARO Full time ₱900,000 - ₱1,200,000 per year

    ECLARO is currently hiring Clinical Appeals Specialists (PHRN) for our BPO client in Bridgetowne.If you're interested, please send your resume toQualifications:Must be an active PHRN license holderAt least 1 year of clinical experience (hospital, clinic, or managed care setting)Minimum of 6 months of clinical process outsourcing experience, with strong...

  • Healthcare Professional

    4 days ago

    Quezon City, National Capital Region, Philippines beBeeClinical Full time ₱800,000 - ₱1,200,000

    Job SummaryClinical Appeal Specialist role available in a dynamic BPO setting.Key ResponsibilitiesAssist with medical necessity reviews and interpretation of clinical documentation.Collaborate with cross-functional teams to ensure accurate and timely appeal resolutions.RequirementsActive PHRN license holder required.Minimum 1 year of clinical experience in...

  • Clinical Appeals Specialist

    16 hours ago

    Quezon City, National Capital Region, Philippines Lean Solutions Group Inc. Full time ₱600,000 per year

    We're looking for PHRNs to join our top BPO client in Quezon CityWhat We Offer:Salary: up to 50,000/monthSign-On Bonus: PHP 50,000 (paid in 3rd & 6th month)Work Setup: Onsite at Bridgetowne, Quezon CitySchedule: ShiftingQualifications:Active Philippine Registered Nurse (PHRN) licenseAt least 1 year of clinical nursing experience (hospital, clinic or managed...

  • PHRN Clinical Appeals Specialist

    15 hours ago

    Quezon City, National Capital Region, Philippines Private Advertiser Full time ₱50,000 - ₱100,000 per year

    **What we offer: Salary Package: PHP 50,000**Sign-On Bonus: PHP 50,000Work Setup: Onsite at Bridgetowne, Quezon CitySchedule: Shifting Schedule Required Qualifications:An active Philippine Registered Nurse (PHRN) license is required.At least 1 year of clinical nursing experience (hospital, clinic, or managed care setting).A minimum of 6 months of Clinical...

  • Senior Clinical Appeals Specialist

    3 days ago

    Makati City, National Capital Region, Philippines beBeeClinical Full time ₱800,000 - ₱1,200,000

    Transforming health outcomes requires a dedicated professional who can deliver clinical support for performing in-depth reviews of appeals. This role also involves reviewing quality of service issues, ensuring compliance with state and federally mandated turn-around-times and process requirements.Deliver high-quality clinical support for the review of...

  • Clinical Insurance Specialist

    4 days ago

    Quezon City, National Capital Region, Philippines beBeeInsurance Full time ₱350,000 - ₱550,000

    Job TitleClinical Insurance SpecialistA clinical insurance specialist performs intermediate level insurance verification and authorization duties with a growing level of responsibility. The position coordinates with clinical departments to ensure accurate scheduling for covered services, resolves moderate issues with payers, and supports pre-visit readiness...

  • Clinical Application Specialist

    15 hours ago

    Quezon City, National Capital Region, Philippines UroServe Enterprises Full time ₱800,000 - ₱1,200,000 per year

    Company DescriptionUroServe Enterprises is dedicated to bridging urological needs by delivering advanced medical technologies and comprehensive clinical support to healthcare providers. As a trusted distributor of innovative urology solutions, we partner with leading global manufacturers to ensure hospitals, clinics, and specialists have access to...

  • Clinical Applications Specialist

    16 hours ago

    Quezon City, National Capital Region, Philippines Royal Arc Med Solution Corporation Full time $60,000 - $80,000 per year

    Company Name: Royal Arc Med Solution Corp.Job Title: Clinical Applications Specialist Position Summary:The Clinical Applications Specialist is responsible for supporting the successful adoption, training, and clinical integration of diagnostic imaging technologies. This role collaborates closely with sales teams, radiologists, technologists, and clinical...

  • Clinical Appeals Consultant

    16 hours ago

    Makati City, National Capital Region, Philippines Optum, a UnitedHealth Group Company Full time $90,000 - $120,000 per year

    ROLE AND RESPONSIBILITIESPosition in this function includes those responsible for management and administration of multiple Medical & Clinical Operations Functions, or managing general operations which are not specific to one of the functions in the Medical & Clinical Operations job family.Provides leadership to and is accountable for the performance of...

  • Clinical Documentation

    16 hours ago

    Quezon City, National Capital Region, Philippines ACCPRO INTERNATIONAL Full time ₱42,000 - ₱54,000 per year

    Clinical Documentation & Coding Specialist (Inpatient)Location: Quezon CityWork Setup: OnsiteWork Shift: To be discussed during interviewCompensation: ₱42,000–₱54,000 base + R1 Allowance + Clinical AllowanceAbout the RoleWe're looking for a detail-oriented and certified Clinical Documentation & Coding Specialist to join our healthcare team in Quezon...