PHRN/ USRN - Clinical Disability Claims

PHRN / USRN – Clinical Disability Claims | Work From Home | Nationwide

Join a Leading Healthcare Team as a Clinical Disability Claims Specialist

We are looking for experienced Philippine Registered Nurses (PHRN) and US Registered Nurses (USRN) with a strong clinical background to join our Clinical Disability Claims team. This is an excellent opportunity for healthcare professionals who have experience in clinical case review and disability claims assessment within the commercial insurance industry.

If you're passionate about combining your clinical expertise with healthcare operations while enjoying a permanent work-from-home setup, we'd love to hear from you.

Key Responsibilities

• Conduct comprehensive clinical reviews of Short-Term and Long-Term Disability claims.
• Assess medical records and supporting documentation to determine claim eligibility.
• Apply clinical judgment to ensure accurate and timely claim decisions.
• Collaborate with internal stakeholders to resolve complex clinical cases.
• Ensure compliance with company policies, clinical guidelines, and regulatory requirements.
• Maintain accurate documentation and meet quality, productivity, and turnaround time standards.
• Deliver high-quality clinical support while maintaining confidentiality and professionalism.

Qualifications

• Active PHRN or USRN license.
• Minimum of 3 years of hospital bedside experience, preferably in intensive care or critical care settings.
• At least 2 years of Clinical Disability Claims experience, preferably handling Short-Term Disability (STD) and Long-Term Disability (LTD) claims.
• Experience conducting Clinical Case Reviews is required.
• Background in private or commercial insurance is required.
• Strong clinical assessment, analytical, and documentation skills.
• Excellent written and verbal communication skills.
• Must not be a current or former employee of the hiring organization.

Why Join Us?

• Permanent Work-from-Home setup.
• Nationwide hiring within the Philippines.
• Competitive salary and comprehensive benefits.
• Opportunity to work with a highly experienced healthcare operations team.
• Career growth in clinical case management and insurance services