Health Admin Services Associate - Voice

Role Overview As a Health Admin Services Associate, you will be responsible for reviewing and processing insurance claim appeals while ensuring compliance with medical policies and regulatory guidelines. This role involves evaluating claim denials, gathering clinical information, and making fair decisions on appeals to maintain trust and satisfaction in the healthcare claims process. You will work as an individual contributor within a team environment, supporting digital transformation in healthcare operations. Key Responsibilities - Review and process appeals for denied insurance claims by evaluating denial reasons and gathering additional clinical documentation - Conduct pre-service and retrospective provider and member appeals for outpatient and inpatient requests - Verify service requests for compliance with applicable medical criteria, policies, member eligibility, benefits and contracts - Route cases to medical staff and nursing reviewers when services do not meet medical necessity or benefit criteria - Conduct medical management review activities by analyzing clinical information against client-specific criteria and guidelines - Communicate with claimants and clinical reviewers to ensure medically necessary and cost-effective healthcare delivery Required Qualifications - Bachelor of Science in Nursing (BSN) degree or General Nursing and Midwifery (GNM) diploma or equivalent nursing qualification - Current and unrestricted local Registered Nurse license with minimum 3 months prior clinical experience - 1 to 3 years of work experience in claims appeals or claims administration - Any undergraduate graduation or diploma qualification - Proficiency in basic computer knowledge with ability to learn additional programs - Excellent written and verbal communication skills in English with US Berlitz B2 level or equivalent language proficiency Why Join Us Accenture is a global professional services company with leading capabilities in digital, cloud and security serving clients in more than 120 countries. Join our team of 784,000 professionals dedicated to delivering technology and human ingenuity to transform healthcare operations and enable streamlined services for emerging healthcare markets.

- Claims appeals and claims administration experience - Registered Nurse license (unrestricted and current) - Bachelor of Science in Nursing or GNM diploma - 1-3 years of professional work experience - Minimum 3 months prior RN clinical experience - American English proficiency with US Berlitz B2 level or Versant score of 58 - Basic computer knowledge and ability to learn software programs - Excellent written and verbal communication skills - Knowledge of medical policy and clinical guidelines - Ability to work in rotational shifts

- Professional development opportunities - Healthcare operations experience - Digital transformation exposure - Global company culture