Healthcare Specialist

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

Key Skills
Revenue Cycle Management,HIPAA,Healthcare Management,PMBOK,Microsoft Outlook,Project Leadership,Data Management,Project Management,Affiliate Marketing,Project Management Software,Supervising Experience,Workday
Employment Type : Full Time
Experience: years
Vacancy: 1