US Registered Nurse – Clinical Claims SME (Onsite, BGC)

ESOL IT SERVICES INC.; Taguig; Hybrid; PHP 360,000 - 720,000; Full time

Job summary

ESOL IT SERVICES INC. is seeking a US Registered Nurse (USRN) to join our Clinical Claims Operations team in BGC, Taguig. The role provides clinical expertise, reviews medical records, and ensures compliance with US healthcare claim processes.

The candidate will coach and support staff, identify process improvements, and balance production targets with SME responsibilities. A BSN and an active USRN license are required, with 2–3 years of US healthcare experience.

Qualifications

• Active and unrestricted USRN license required.
• Bachelor's Degree in Nursing (BSN) required.
• 2–3 years of US healthcare experience in areas such as Disability Claims, Clinical Claims Review, Utilization Management, Case Management, Workers' Compensation, Medical Review, or Insurance Claims Operations.
• Strong knowledge of medical terminology, clinical documentation, and US healthcare or insurance processes.
• Excellent analytical, communication, and problem-solving skills.
• Coaching, mentoring, or SME experience is an advantage.
• Proficient in Microsoft Office applications.
• Willingness to work flexible or shifting schedules.
• Willing to work onsite in BGC, Taguig, with potential to transition to WAH once program stabilizes.

Responsibilities

• Provide clinical expertise and guidance to the Clinical Claims Operations team.
• Review and interpret medical records, clinical documentation, and claims information.
• Ensure accuracy and compliance with clinical review guidelines and insurance processes.
• Handle complex clinical concerns and provide guidance on escalated cases.
• Coach and support team members through knowledge sharing and process clarification.
• Identify operational gaps and recommend process improvements.
• Balance individual production targets with SME support responsibilities.

Skills

Analytical skills

Communication skills

Problem-solving skills

Coaching/mentoring/SME experience

MS Office

Education

Bachelor's Degree in Nursing (BSN)

Tools

Microsoft Office

Job description

ESOL IT SERVICES INC. is seeking a US Registered Nurse (USRN) to join our Clinical Claims Operations team in BGC, Taguig. The role provides clinical expertise, reviews medical records, and ensures compliance with US healthcare claim processes.

The candidate will coach and support staff, identify process improvements, and balance production targets with SME responsibilities. A BSN and an active USRN license are required, with 2–3 years of US healthcare experience.