Quality Risk Adjustment Operations

Positions in this function are responsible for providing expertise or general support in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. Communicates with appropriate parties issues, implications and decisions. Analyzes and identifies trends for appeals and grievances. This includes senior level positions with education/certification/licensure other than an RN, such as BSW, MSW, DDS, Chiropractor, Physical Therapist, etc. (Positions responsible for claims appeals can be found in the Claims job family.)- Moderate work experience within own function.- Some work is completed without established procedures.- Basic tasks are completed without review by others.- Supervision/guidance is required for higher level tasks.**Qualification**:- Medical Allied Graduate - Licensed or Underboard**Salary**: Php17,000.00 - Php20,000.00 per monthSchedule:- Day shift