RN Clinical Appeals Specialist – Medical Necessity & NCQA

NTT DATA, Inc. is seeking a BPO Clinical Review Specialist to join the team in Manila, National Capital Region, Philippines. The role involves performing clinical reviews to resolve appeals by reviewing medical records in accordance with NCQA standards.

Candidates should have 1-3 years of experience in processing appeals, an RN license, and a solid understanding of utilization management and Medicaid regulations. Strong analytic and communication skills are essential.