USRN – Clinical Disability Claims Specialist

*EXL | PHRN / USRN – Clinical Disability Claims Specialist*  

*Location:Work From Home 

*Work Setup:* Full-time, Shifting Schedule 

*Salary & Benefits*  

- Basic Pay: PHP 60,700 – PHP 85,700/month  

- Complexity Pay: +PHP 3,000/month  

- Standard Allowance: PHP 2,675/month  

- Work From Home setup | HMO + Government benefits  

- Career growth in Healthcare/Insurance RCM  

*Job Description*  

Perform Clinical Case Review for Disability Claims on a Short Term/Long Term Disability account. Review medical files, assess clinical documentation, and ensure accurate evaluation per insurance guidelines.

*Key Responsibilities*  

- Conduct clinical file review for Short Term/Long Term Disability claims  

- Evaluate medical records and clinical documentation for accuracy and completeness  

- Apply private/commercial insurance guidelines to case assessments  

- Ensure compliance with client-specific clinical criteria  

- Maintain quality and turnaround time standards  

*Required Qualifications*  

- *License:* Must have an active PHRN or USRN license  

- *Experience:* Clinical Disability Claims experience required, preferably in Short Term/Long Term Disability with clinical file review  

- Insurance Background: Experience in private or commercial insurance required  

- Clinical Role: Must be actively doing or have done Clinical Case Review  

- *Bedside Experience:* With or without hospital bedside experience is acceptable  

- *Eligibility:* Should not be a former or current employee of the client