Healthcare Specialist

1 hour ago

Pasig, National Capital Region, Philippines TASQ Staffing Solutions Full time ₱800,000 - ₱1,200,000 per year

WITH SIGNING BONUS*
Setup: On-site in Ortigas, Pasig
Schedule: Shifting schedule (predominantly night shift)

Role Requirements:

  • Must have an active PHRN license
  • With or without BPO experience
  • Also open to PHRNs with at least 1 year in prior authorization OR eligibility, claims, and benefits (payer)
  • Good English communication skills
  • Knowledge of healthcare regulations and compliance
  • Start dates:
    • Dec. 15, 2025
    • Jan. 12, 2026
    • Jan. 19, 2026
    • Jan. 29, 2026 (PHRNs w/ 1 yr PA/Eligibility/Claims/Benefits exp.)

* Signing bonus - Terms and conditions apply

Responsibilities:

Coverage and Access Specialist (PHRN)

  • Professionally and compliantly interact with insurance payer representatives during outbound phone calls for benefit verifications (New BVs, Annual reverification BVs, and Bridge Eligibility Checks) and coverage exception follow-up calls (Prior Authorization (PAS), Non-Formulary Exceptions (NFEs,) and Appeals)
  • Volume and case type to be worked to be determined by Novartis, but in collaboration with the supplier, based on current SLAs within the PSC and expected agent productivity
  • Accurately and concisely document payer interactions to inform cross-functional partners on the patients' coverage status

Care Navigator (PHRN)

  • Develop and maintain Subject Matter Expert (SME) level knowledge of the relevant brand and customer workstreams for the specific assigned program
  • Learn and utilize protocols to respond to customer phone, chat, fax, SMS/text, mail, and e-mail inquiries, as well as other communication channels, in a prompt and courteous manner
  • Professionally and compliantly interact with customers, relevant Novartis associates, and other external contacts during inbound and outbound phone calls
  • Manage assigned cases throughout the patient journey; perform proper and timely escalation, tracking, triage, and follow-up where required

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