PHRN – Grievance & Case Appeals Specialist

WORK SETUP: Full Onsite during Training; 2x per week Onsite once in Production

WORK SHIFT: Night Shift

SALARY: ₱47,000 Max (including license allowance)

TARGET START DATE: October 13, 2026

Role Overview

We are seeking an active PHRN (Philippine Registered Nurse) to join our team as a Grievance & Case Appeals Specialist. This is a back-office (non-voice) role responsible for reviewing and resolving grievance and case appeals. You will leverage your clinical expertise to assess cases, ensure compliance with guidelines, and support timely resolution.


Key Responsibilities

Review and process grievance and case appeals


Assess clinical documentation and medical necessity


Ensure compliance with regulatory and client guidelines


Collaborate with internal teams to resolve complex cases


Document findings and determinations accurately


Meet quality, productivity, and turnaround time targets


Qualifications

PHRN with active license – required


Active Registered Nurse – required


Must have at least 1 year of grievance & case appeals experience – required


Back-office (non-voice) – required


Willing to work on night shift schedule and attend training onsite; once in production, 2x a week onsite – required


Job hoppers who change jobs frequently in less than a year should be rejected


Why Join?

Competitive salary: ₱47,000 Max (including license allowance)


Hybrid work setup after training


Career growth in healthcare appeals and utilization management


Night shift schedule