job description
WNS is a global leader in Business Process Management (BPM), and we are seeking dedicated PHRN Specialists to join our growing healthcare team in Bali. In this role, you will be the face of compassion and professionalism, representing both WNS and our prestigious global clients. We are looking for individuals who can seamlessly blend clinical expertise with exceptional communication skills to provide top-tier support in the healthcare domain.
As a PHRN Specialist, you will work within a dynamic environment where your nursing background is leveraged to ensure compliance with medical guidelines and process protocols. You will be responsible for delivering high-quality service while maintaining the dignity of every member and patient you interact with. This is a unique opportunity to transition your clinical skills into a corporate setting that offers significant growth, a competitive compensation package, and a substantial 50K annual bonus for high performers.
Join a company that values integrity, innovation, and people-centric service. Whether you are conducting medical reviews or managing patient inquiries, your work at WNS will directly impact the quality of care and operational excellence we provide to the healthcare industry worldwide.
Responsibility
- Conduct thorough clinical reviews of medical records to ensure compliance with established guidelines and protocols.
- Represent WNS and its clients by providing compassionate and professional assistance to members and healthcare providers.
- Perform utilization management and case review activities to determine medical necessity and appropriateness of care.
- Document all clinical findings and interactions accurately within the system to maintain a clear audit trail.
- Collaborate with multidisciplinary teams to resolve complex medical inquiries and improve process efficiency.
- Adhere strictly to HIPAA regulations and data privacy standards to protect sensitive patient information.
- Participate in pooling and training sessions to stay updated on the latest healthcare trends and client-specific requirements.
Qualifications
- Must be a Philippine Registered Nurse (PHRN) with a current and active PRC license.
- Minimum of 1-2 years of clinical experience in a hospital or community health setting is preferred.
- Previous experience in a BPO or healthcare insurance environment (Utilization Review, Case Management) is a strong advantage.
- Excellent verbal and written English communication skills for professional client interaction.
- Strong analytical and decision-making skills with a high attention to detail.
- Ability to work in a fast-paced environment and adapt to shifting priorities.
- Proficiency in basic computer applications and electronic medical records (EMR) systems.