Healthcare Specialist

Pasig - Philippines

Monthly Salary: Not Disclosed

Posted on: 5 hours ago

Vacancies: 1 Vacancy

Job Summary

WITH SIGNING BONUS!*
Setup: On-site in Ortigas Pasig
Schedule: Shifting schedule (predominantly night shift)

Role Requirements:

Must have an active PHRN license
With or without BPO experience
Also open to PHRNs with at least 1 year in prior authorization OR eligibility claims and benefits (payer)
Good English communication skills
Knowledge of healthcare regulations and compliance
Start dates:
- Dec. 15 2025
- Jan. 12 2026
- Jan. 19 2026
- Jan. 29 2026 (PHRNs w/ 1 yr PA/Eligibility/Claims/Benefits exp.)

* Signing bonus - Terms and conditions apply

Responsibilities:

Coverage and Access Specialist (PHRN)

Professionally and compliantly interact with insurance payer representatives during outbound phone calls for benefit verifications (New BVs Annual reverification BVs and Bridge Eligibility Checks) and coverage exception follow-up calls (Prior Authorization (PAS) Non-Formulary Exceptions (NFEs) and Appeals)
Volume and case type to be worked to be determined by Novartis but in collaboration with the supplier based on current SLAs within the PSC and expected agent productivity
Accurately and concisely document payer interactions to inform cross-functional partners on the patients coverage status

Care Navigator (PHRN)

Develop and maintain Subject Matter Expert (SME) level knowledge of the relevant brand and customer workstreams for the specific assigned program
Learn and utilize protocols to respond to customer phone chat fax SMS/text mail and e-mail inquiries as well as other communication channels in a prompt and courteous manner
Professionally and compliantly interact with customers relevant Novartis associates and other external contacts during inbound and outbound phone calls
Manage assigned cases throughout the patient journey; perform proper and timely escalation tracking triage and follow-up where required

WITH SIGNING BONUS!*Setup: On-site in Ortigas PasigSchedule: Shifting schedule (predominantly night shift) Role Requirements: Must have an active PHRN licenseWith or without BPO experienceAlso open to PHRNs with at least 1 year in prior authorization OR eligibility claims and benefits (payer)Good En...