USRN Clinical Review Specialist

USRN – Clinical Claims / Utilization Review

What You'll Do

• Review medical records and claims using your clinical knowledge.
• Assess complex cases and make accurate, evidence-based decisions.
• Analyze medical information and provide clear clinical conclusions.
• Communicate with employees, patients/members, doctors, and internal teams to clarify medical information.
• Handle sensitive and challenging conversations professionally.
• Provide guidance to non-medical teams on clinical matters.
• Ensure accuracy, quality, and productivity in handling cases.
• Stay updated on medical standards, practices, and industry developments.

What We're Looking For

• Active US Registered Nurse (USRN) License
• At least 1–2 years of Clinical / Hospital / Bedside experience
• At least 1 year of Clinical Claims / Utilization Review experience
• Willing to work on a hybrid setup in BGC, Taguig

What's in it for you

• Be part of one of the largest, independent process transformation companies in the world and serve marquee clients in major industry verticals
• Growth and advancement opportunities
• Performance Based Incentive
• HMO after 6 months
• Life Insurance upon hiring