Operations Manager for Appeals - PHRN
Gratitude IncOperations Manager for Appeals - PHRN
Job Description
Key Skills
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Job Title: Operations Manager for Appeals - PHRN
Shift: Night shift
Work Set-up: On-site in Bridgetowne, Quezon City
Salary range: 120K to 150K
HC: 1
Start date: Dec 31, 2025/ ASAP
Recruitment Process: 2 interviews with Ops/virtual, Assessment depends on the recommendations after the interviews
LOB DESCRIPTION: Medical necessity review for appeals (Claims denied due to medical necessity)
JOB SUMMARY:
The Operations Manager for Appeals is responsible for managing and overseeing operations related to clinical appeals, ensuring compliance with industry standards and regulatory requirements. The role involves close collaboration with various stakeholders to drive performance and maintain high-quality standards.
QUALIFICATIONS:
• Bachelor's Degree in Nursing with an active and valid license in PHRN
• Must have at least 1 or 2 years in a managerial role handling leaders/ TLs/ Supervisors
• Experience in managing teams handling Clinical Appeals
• Experience in handling appeals, utilization review, or related healthcare management functions
• Excellent verbal and written communication skills
• Willingness to work on-site with flexible schedules, including US hours and holidays
• Must not be a current or former employee of Concentrix
KEY RESPONSIBILITIES:
• Oversee daily operations and ensure compliance with SLAs and regulatory standards.
• Developer and implement process improvement initiatives.
• Collaborate with internal and client stakeholders to enhance service delivery and maintain accurate staffing.
• Ensure adherence to HIPAA and other regulatory requirements.
PRE-SCREENING QUESTIONS:
1. Do you have an active PHRN license?
2. How many years of experience do you have in managing teams handling Clinical appeals for a healthcare or BPO/CPO setting?
3. How many years of managerial experience do you have?
4. Please provide your years of experience in handling clinical appeals and share a brief experience on the process.
5. Do you have strong knowledge and understanding of HIPAA and other regulatory requirements?
6. How much is your last drawn salary?
7. How much is your salary expectation?
8. Are you amenable to working onsite in Bridgetowne, Quezon City, with a night shift and fixed weekends off schedule?
9. When can you start once hired?
Role
Any Other
Timings
Night Shift (Permanent)
Industry
BPO
Work Mode
Work from office
Functional Area
Any Other
Note: Myglit doesn't charge any money from candidates. If you have been asked to pay money to get this job then report to us immediately at support@myglit.com.
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