claims management analyst | philippine Registered Nurse | 40,000* hiring bonusAccenture Thailand

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Duties and Responsibilities:
Claims Management for Absence and Disability Insurance Analysts and Senior Analysts gather information and perform a variety of administrative support functions, which requires the knowledge and understanding of disability policies and procedures to appropriately calculate the benefits due and manage the duration of a disability absence. Tasks and responsibilities include:
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.
Qualifications:
Bachelor of Science Nursing (BSN) degree
Philippine Registered Nurse license is required
Minimum 6 months experience in a CSR role
Minimum 1-year experience in any account or case or project management work (preferably Case management work with experience reviewing eligibility, determining appropriate benefits that apply and establish a case management plan.)
Claims reviews/audit experience or US Healthcare Administration/Management experience is needed
Absence and/or Disability Insurance experience is an advantage
Excellent written and verbal communication skills in English
Why join Accenture?
Competitive salary package, company bonuses, and performance incentives
Night differential
Loyalty, Christmas gift, Inclusion and diversity benefits
Paid sick and vacation leaves
Expanded maternity leave up to 120 days*
HMO coverage (medical and dental) from day 1 of employment
Life insurance
Employee stock purchase plan
Retirement plan
Flexible working arrangements
Accessible locations
Healthy and encouraging work environment
Career growth and promotion opportunities
*Terms and conditions apply