Shift: Monday - Friday, 10:30 PM - 7:30 AM Philippine Time
Rate: Php40,000 - 50,000/monthly
KEY RESPONSIBILITIES:
1. Full-Cycle Case Management & Strategy
- Intake & Suitability Assessment: Conduct intake calls to determine if a case is appropriate for funding based on accident details and insurance policy limits.
- Clinical Analysis: Review medical reports and physical therapy notes to identify injuries (e.g., cervical/thoracic pain) and monitor treatment progress.
- Causality & Red Flag Identification: Actively monitor for treatment red flags, such as regressing patient progress, to determine if conservative care should be swapped for more effective, higher-value interventions like injections or surgery.
- Surgical & High-Cost Coordination: Secure necessary approvals for expensive procedures; coordinate pre-ops, lab work, and post-operative care.
2. Financial & Lien Oversight
- Policy Limit Gatekeeping: Monitor medical billing and treatment plans daily to ensure all costs remain strictly within the patient's insurance policy limits.
- Funding Approvals: Act as an internal adjuster to approve or deny orders for MRIs, X-rays, and pain management procedures.
- Master Ledger Management: Gather all final medical records, bills, and documentation to create a Master Ledger for the law firm's litigation and demand process.
3. Network & Logistics Coordination
- Provider Relations: Serve as the primary bridge between the patient, medical providers, and attorneys to ensure smooth case progression.
- Patient Support: Coordinate patient logistics, including pharmacy medications and transportation (lifts) to appointments to ensure treatment compliance.
- Caseload Maintenance: Utilize CRMs (e.g., Contact Manager, Filevine) to touch every case in the pipeline daily, ensuring no case stagnates.
- Radius & Compliance Management: Locate and vet providers near the patient's residence to minimize no-show rates and ensure treatment consistency.
- Cycle Management: Actively push cases through the Treatment Phase to ensure the file is ready for the Settlement Phase without unnecessary delays.
QUALIFICATIONS:
Technical Skills & Experience
- US Medical Lien Expertise: Must have direct experience working for a US-based Medical Lien or Funding company (experience in Utah, Colorado, or similar at-fault states is a plus).
- Medical Literacy: Ability to interpret CPT codes, surgical recommendations, and diagnostic results (MRIs/X-rays) independently. Review initial medical reports to assess injury severity and classify cases (e.g., conservative care vs. surgical intervention).
- Legal Lifecycle Knowledge: Deep understanding of the Personal Injury (PI) lifecycle, from initial intake and LOP (Letter of Protection) filing to the final demand/settlement phase.
- Clinical Justification: Analyze daily medical notes to validate the necessity of advanced treatments (MRIs, injections, etc.) before funding is approved.
- Causality Verification: Ensure treatment plans are directly tied to the motor vehicle accident (MVA) and differentiate new injuries from pre-existing conditions to protect the lien value.
Software & Soft Skills
- CRM Proficiency: Experience using legal/medical case management software (e.g., Contact Manager, Filevine, Salesforce).
- Assertive Communication: Strong interpersonal skills for negotiating with provider offices and providing clear updates to attorneys.
- Detail Oriented: Proven ability to manage complex documentation requirements for high-cost surgeries and legal evidence
Preferred (Bonus) Qualifications
- Medical Background: Degree in Nursing (BSN) or a related healthcare field.
- Multi-State Policy Knowledge: Understanding of how insurance policies and lien laws differ across various US states.
