Health Clinical Services Senior Manager

On-site - Taguig >10 Yrs Exp Bachelor Full-time

Job Description

Employee Recognition and Rewards

Performance Bonus, Incentives

Government Mandated Benefits

13th Month Pay, Pag-Ibig Fund, Paid Holidays

Insurance Health & Wellness

HMO

Responsibilities:

• Oversees staff whose teams’ primary duties may include, but are not limited to:
• Conducts pre-service, concurrent, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
• Service requests may be from inbound calls and facsimile.
• Outbound calls to the provider may be required to gather additional information that may be needed.
• Other staff responsibilities may be review and analysis of post service claims utilizing the member’s benefit contract and health plan guidelines.
...