ESSENTIAL RESPONSIBILITIES Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims are properly routed and paid. Conduct research beyond
Team Leader for Utilization Management Healthcare Operations Work Set-up: Onsite - Potential to WFH after training Location: Valero, Makati City Schedule: Graveyard | Shifting Hours Position Summary The Utilization Management Operations Team Leader is responsible for leading the
Description HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. Were experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize
We are looking for a USRN Utilization Review Specialist responsible for reviewing clinical information, medical records, and patient cases to determine the medical necessity, appropriateness, and level of care based on established clinical guidelines and payer requirements. The
USRN Team Lead – Active USRN & PHRN with BPO Team Lead and Utilization Review Experience Required Work Setup: Onsite – Ortigas, Manila Shift: Nightshift Salary Package: Up to PHP 90,000 (depending on experience) Start Date: ASAP We are currently hiring
USRN Team Lead – Active USRN & PHRN with BPO Team Lead and Utilization Review Experience Required Work Setup: Onsite – Ortigas, Manila Shift: Nightshift Salary Package: Up to PHP 90,000 (depending on experience) Start Date: ASAP We are currently hiring
About Analog Devices Analog Devices, Inc. (NASDAQ: ADI) is a global semiconductor leader that bridges the physical and digital worlds to enable breakthroughs at the Intelligent Edge. ADI combines analog, digital, AI, and software technologies into
OUR STORY At STMicroelectronics, we believe in the power of technology to drive innovation and make a positive impact on people, businesses, and society. As a global semiconductor company, our advanced technologies and chips form the
At Johnson & Johnson,we believe health is everything. Our strength in healthcare innovation empowers us to build aworld where complex diseases are prevented, treated, and cured,where treatments are smarter and less invasive, andsolutions are personal.Through our
SPECIFIC DUTIES AND RESPONSIBILITIES Develop, enhance, and maintain backend services and APIs using Java 21, Spring Framework 5/6, and Spring Boot 3/4, following industry best practices. Design, implement, and document RESTful APIs, ensuring reliable integration with
Job Description This role will ensure delivery for incident recovery, network changes and adherence to configuration standards. The Network Engineer needs to apply technical expertise in routing and switching (Cisco IOS and Nexus especially) and load-balancing
What Customer Service Operations contributes to Cardinal Health Customer Service is responsible for establishing, maintaining and enhancing customer business through contract administration, customer orders, and problem resolution. Customer Service Operations is responsible for providing services to
At JTI we celebrate differences, and everyone truly belongs. 46,000 people from all over the world are continuously building their unique success story with us. 83% of employees feel happy working at JTI. To make a
The Senior Legal Manager is responsible for providing strategic legal, regulatory, governance, data privacy, and distribution compliance support to the Company and its subsidiaries and affiliates. The role reports directly to the General Counsel and supports
At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone. It’s about finding new ways to not only better peoples lives, but to better the communities and environments we live
Toyota Motor Philippines is looking for an Aftersales Area Operations Officer to join our Dealer Operations Department based in Sta. Rosa, Laguna, Philippines. In this role, you are expected to be a domain expert in monitoring
Dayforce is a global human capital management (HCM) company headquartered in Toronto, Ontario, and Minneapolis, Minnesota, with operations across North America, Europe, Middle East, Africa (EMEA), and the Asia Pacific Japan (APJ) region. Our award-winning Cloud
Job Description: Leads the overall delivery management of each project under within the managed portfolio ensuring such are delivered on-time, on-budget, and on-scope. Defines and finalize project scope, goals and deliverables that support business goals in
About this role: Wells Fargo is seeking a Technology Operations Analyst (Workforce Planning). In this role, you will: Participate in initiatives and identify opportunities for technology operations Evaluate basic or tactical challenges that require research and
Company Description Work with Us. Change the World. At AECOM, were delivering a better world. Whether improving your commute, keeping the lights on, providing access to clean water, or transforming skylines, our work helps people and