(ACTIVE-URGENT) PHRN/ USRN Healthcare Clinical Disability Claims | WFH

Gratitude Inc

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2 days ago

(ACTIVE-URGENT) PHRN/ USRN Healthcare Clinical Disability Claims | WFH

5-10 Year(s)

Manila
(Base Location for WFH)

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Job Description

Key Skills

USRN PHRN Healthcare Insurance Medical Claims processing ICU/CCU nursing experience Hospital bedside experience Clinical disability claims

14 candidate(s) have already applied for this Job. Apply now

Job Title: PHRN/USRN – Clinical Disability Claims

Project: AMERON
Location: Nationwide, Philippines
Work Setup: Work From Home
Shift: Shifting Schedule
Employment Type: Permanent
Salary: Confidential (Based on experience)
Headcount: 3
Target Start Date: TBD

Job Summary

We are looking for experienced PHRN or USRN professionals with a background in Clinical Disability Claims and hospital bedside care. The ideal candidate should have experience handling clinical case reviews for Short-Term Disability (STD) and Long-Term Disability (LTD) claims in a private or commercial insurance environment.

Key Responsibilities

Conduct clinical case reviews for disability claims.
Evaluate Short-Term and Long-Term Disability claims based on clinical documentation.
Review medical records and determine claim eligibility according to clinical guidelines.
Ensure accurate and timely claim decisions while maintaining quality standards.
Collaborate with internal teams to resolve claim-related concerns.
Maintain compliance with company policies and healthcare regulations.

Qualifications

Active PHRN or USRN license.
Minimum 3 years of hospital bedside experience, preferably in intensive care.
Minimum 2 years of Clinical Disability Claims experience.
Experience handling Short-Term Disability (STD) and/or Long-Term Disability (LTD) claims.
Experience in private or commercial insurance is required.
Experience conducting Clinical Case Reviews.
Strong analytical, documentation, and communication skills.
Must not be a current or former employee of the client.

Preferred Background

Candidates from companies such as:

Genpact
Optum
VXI
Accenture

Recruitment Process

Initial Screening
Profile Validation
Virtual Interview (10:00 AM – 5:00 PM)
Operations Interviews
Final Selection

Pre-Screening Questions

Do you have an active PHRN or USRN license?
How many years of hospital bedside experience do you have?
How many years of Clinical Disability Claims experience do you have?
Do you have experience with Short-Term or Long-Term Disability claims?
Have you worked in private or commercial insurance?
Are you willing to work from home on a shifting schedule?
What is your current salary?
What is your expected salary?
What is your notice period?

Role

Nurse

Timings

Rotational Shifts (Permanent)

Industry

Medical / Healthcare / Hospital

Work Mode

Work from Home

Process

Non-Voice

Functional Area

Medical Professional / Healthcare Practitioner / Technician

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