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MicroSourcing

Utilization and Denials Management Auditor

MicroSourcing
Taguig, Philippines
3-5 Years
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Job Description

Discover your 100% YOU with MicroSourcing!

Position: Utilization and Denials Management Auditor
Location: Taguig
Work setup & shift: Onsite | Night shift

Why join MicroSourcing
Youu0027ll have:
  • Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life insurance, and performance bonuses
  • A Collaborative Spirit: Contribute to a positive and engaging work environment by participating in company-sponsored events and activities.
  • Work-Life Harmony: Enjoy the balance between work and life that suits you with flexible work arrangements.
  • Career Growth: Take advantage of opportunities for continuous learning and career advancement.
  • Inclusive Teamwork: Be part of a team that celebrates diversity and fosters an inclusive culture.
Your Role
As a Utilization and Denials Management Auditor, you will:
Quality Assurance (QA) & Delivery
  • Support the build and execution of the QA program, including identifying critical workflows/accounts to audit and advising on effective audit attributes.
  • Monitor performance of Utilization and Denials Management staff using key productivity and accuracy metrics across Utilization Management and Clinical Denials & Appeals.
  • Escalate production and QA risks or roadblocks to the Manager and collaborate with Training teams to communicate progress and improvement plans.
  • Demonstrate domain expertise in production schedules, quality processes, and clinical documentation of diagnoses and treatment practices.
  • Apply a deep understanding of Utilization and Denials Management workflows, guidelines, and QA standards.
QA Administration & Documentation
  • Provide training, coaching, and ongoing feedback to team members on quality and performance.
  • Maintain and monitor QA records, audit results, and education findings for assigned staff.
  • Complete special projects, including full Utilization and Denials Management audits, in a timely manner.
  • Mentor staff to maximize performance, engagement, and professional growth.
  • Assist in monitoring team morale and job satisfaction.
Performance & Evaluation
  • Review production and quality accuracy reports and system dashboards share actionable feedback with team members and leadership.
  • Motivate team members through effective coaching and training to improve quality, professionalism, and consistency.
  • Conduct monthly team meetings and participate in annual performance evaluations.
Collaboration & Stakeholder Management
  • Partner with global Operations, Training, and HR teams to support onboarding and on-the-job learning (OJL).
  • Participate in client calibration calls to align training KPIs with operational metrics.
  • Support client visits, internal audits, and process reviews by presenting QA insights, dashboards, and outcomes.
  • Perform other duties and responsibilities as assigned.
What You Need
Non-negotiables
  • Minimum 1 year of QA or auditing experience in Utilization Management and/or Clinical Denials & Appeals within a healthcare setting.
  • 3-5 years of acute care clinical experience in a hospital setting (Med/Surg or similar preferred

More Info

Job Type:
Permanent Job
Industry:
IT/Computers - Software
Function:
Healthcare
Employment Type:
Full time

About Company

MicroSourcing

Founded in 2006, we pioneered a new way of offshoring. This model involves setting up an overseas division of your company and getting a local specialist to handle facilities, IT, labor laws, recruitment and HR, while you retain control over quality and productivity. Today, we&#8217&#x3B;re still one of the largest and most experienced offshoring providers in the Philippines, with 400+ active clients and 6,000+ employees. We operate within purpose-built, class-A facilities that are strategically located for access to Manila&#8217&#x3B;s most talented people. We&#8217&#x3B;re backed by our Australian parent company, Probe and we&#8217&#x3B;re ISO certified.

Job ID: 136336385

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Last Updated: 19-12-2025 08:43:02 AM
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