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.