Job Description

• Manages incoming or outgoing telephone calls, emails, and/or faxes, including triage, opening of cases and data entry into client system.

• Determines contract; verifies eligibility and benefits.

• Adhere to federal and state regulatory and/or client plan requirements and established workflows.

• Obtains information from claimant or other supporting systems, emails and/or from fax. Manages claims, collection of non-clinical information needed for review from claimants and providers, utilizing scripts to screen basic and complex requests.

• Data entry of contact into client systems and route as appropriate.

• Tasks cases accurately to the correct queue.

• Performs leave follow-ups as required, including recertification of health conditions, intermittent claim tracking, Return to Work confirmation, etc.

• Update systems to accurately reflect leave status and ensure appropriate documentation exists.

• Conducts outbound scripted calls to claimants and providers to request for clinical information.

• Review and assessment of primarily complex illness and injury claims.

• Identify restrictions and limitations based on physiological, psychological, and social factors to assist claim management staff in their claim handling activities.

• Validate the medical necessity of limitations and/or restrictions with clear rationale.

• Provide claim management staff with medical insight and education to assist them in determining appropriate determination.

• Discuss medical issues and documents outcomes of discussions.

• Uses available resources to understand contractual and regulatory compliance requirements and reports suspected compliance issues on the day of discovery to a Team Lead, Manager, and/or the Compliance Department.

• Responsible for reporting known or suspected data disclosures or fraud on the day of discovery to a Team Lead.


• Graduate of Bachelor’s Degree in Nursing • Holds active and unrestricted local (PH) Registered Nurse license • Must have at least 3 months experience as a Registered Nurse in a clinical setting • Experience in a front-office (voice) call center or BPO back-office environment is an advantage • Knowledge of ICD-9 and ICD-10 and CPT codes is an advantage • Must be amenable to work in Cubao, Eastwood, Mandaluyong, and other possible Accenture sites in Metro Manila

All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.

Accenture is committed to providing veteran employment opportunities to our service men and women.

Please read Accenture’s Recruiting and Hiring Statement for more information on how we process your data during the Recruiting and Hiring process.

COVID-19 update:  The safety and well-being of our candidates, our people and their families continues to be a top priority. Until travel restrictions change, interviews will continue to be conducted virtually. 

Life at Accenture

Work where you're inspired to explore your passions and where your talents are nurtured and cultivated. Innovate with leading-edge technologies on some of the coolest projects you can imagine.


Training and Development

Take time away to learn and learn all the time in our regional learning hubs, connected classrooms, online courses and learning boards.



Work Environment

Be your best every day in a work environment that helps drive innovation in everything you do.


View All

Learn more about Accenture

Our more than 700,000 people in more than 120 countries, combine unmatched experience and specialized skills across more than 40 industries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.

View All

Stay connected

Join our Team

Join Our Team

Search open positions that match your skills and interest. We look for passionate, curious, creative and solution-driven team players.

Keep up to date

Keep Up to Date

Stay ahead with careers tips, insider perspectives, and industry-leading insights you can put to use today–all from the people who work here.

Stay Connected

Job Alert Emails

Personalize your subscription to receive job alerts, latest news and insider tips tailored to your preferences. See what exciting and rewarding opportunities await.

View All