Job Description

Work Setup: Onsite (McKinley Taguig)

Start Date: ASAP

Requirements:

• Active Pharmacist license in the Philippines
• At least 1 year of BPO Clinical / Healthcare experience or 1 year of pharmacy experience
• Strong English communication skills
• Willing to work onsite in McKinley, Taguig
• Amenable to be on a shifting schedule – predominantly on night shift with no guaranteed weekends off

Responsibilities:

• Clinical Review & Documentation: Analyzing medical records for accuracy, compliance, and appropriateness of care.
• Claims Processing: Determining patient eligibility, validating medical claims, and managing insurance coverage.
• Utilization Management: Reviewing treatment plans against medical policies to ensure cost-effective care.
• Case Management & Liaison: Communicating with healthcare providers and patients to facilitate care and resolve inquiries.
• Clinical Training (if applicable): Developing or delivering training programs for healthcare staff.