Clinical Claims Nurse Specialist

Siegen HR Solutions; Manila; On-site; PHP 279,000 - 390,600; Full time

Job summary

A healthcare staffing agency is seeking a Registered Nurse in Manila to support clinical teams and manage member claims. The ideal candidate will have a BS Nursing degree and an active PHRN license, with at least three months of clinical experience. Responsibilities include assessing claims for medical appropriateness and ensuring timely payments. Experience in customer service is a plus for this role, which aims to optimize member benefits and ensure high-quality service.

Qualifications

• Minimum three (3) months of working experience as a Registered Nurse in a clinical setting.
• Direct patient care experience required.

Responsibilities

• Provide support to the clinical team to promote quality member outcomes.
• Assess medical appropriateness of claims and adjust as needed.
• Manage both new and open claims effectively.

Skills

Customer service skills

Clinical assessment

Education

BS Nursing (BSN) Degree

Active PHRN License

Job description

A healthcare staffing agency is seeking a Registered Nurse in Manila to support clinical teams and manage member claims. The ideal candidate will have a BS Nursing degree and an active PHRN license, with at least three months of clinical experience. Responsibilities include assessing claims for medical appropriateness and ensuring timely payments. Experience in customer service is a plus for this role, which aims to optimize member benefits and ensure high-quality service.