PHRN/USRN Healthcare Clinical Disability Claims (WFH)

Gratitude Inc

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1 week ago

PHRN/USRN Healthcare Clinical Disability Claims (WFH)

2-5 Year(s)

Manila (Pasay City)
(Base Location for WFH)

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Job Description

Key Skills

medical record system active PHRN License active PHRN and USRN license

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Job Summary

We are looking for a licensed Philippine Registered Nurse (PHRN) or US Registered Nurse (USRN) to join our Clinical Disability Claims team. The role involves reviewing clinical records and evaluating disability claims for short-term and long-term disability benefits. The ideal candidate should have experience in clinical case review within a private or commercial insurance environment and possess strong analytical and documentation skills.

Work From Home (Nationwide)

Work Schedule: Shifting

Key Responsibilities

Review and assess clinical documentation for disability claims.
Perform clinical case reviews to determine eligibility for short-term and long-term disability benefits.
Analyze medical records, treatment plans, and physician documentation.
Ensure claim decisions comply with company policies and clinical guidelines.
Prepare accurate and comprehensive case documentation.
Coordinate with internal teams to obtain additional medical information when required.
Maintain confidentiality and compliance with healthcare and insurance regulations.
Meet quality, productivity, and turnaround time targets.

Required Skills

Technical Skills

Active PHRN or USRN license.
Clinical Disability Claims experience (Short-Term Disability/Long-Term Disability preferred).
Clinical Case Review experience.
Experience reviewing medical records and clinical documentation.
Knowledge of disability claims adjudication.
Experience in private/commercial health insurance.
Medical documentation analysis.
Strong clinical assessment skills.
Computer proficiency (MS Office and claims management systems).

Soft Skills

Strong analytical and critical thinking skills.
Excellent written and verbal communication.
Attention to detail.
Good decision-making ability.
Time management.
Ability to work independently in a remote setup.
Problem-solving skills.
Confidentiality and professionalism.

Mandatory Requirements

Active PHRN or USRN license.
Experience in Clinical Disability Claims.
Experience in Clinical Case Review.
Experience in private/commercial insurance (not government insurance such as VA/Veterans accounts).
Work-from-home ready.
Must not be a former or current employee of the client.

Role

Nurse

Timings

Rotational Shifts (Permanent)

Industry

Health/Fitness/Wellness

Work Mode

Work from Home

Functional Area

Medical Professional / Healthcare Practitioner / Technician

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