US Registered Nurse (USRN) | BPO

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

US REGISTERED NURSE (USRN)

Location: BGC, Taguig City
Employment Type: Full-time
Work Arrangement: Onsite
Start Date: ASAP

Job Summary

We are looking for an experienced US Registered Nurse (USRN) to join our Clinical Claims Operations team.

The successful candidate will provide clinical expertise and guidance in supporting US healthcare claims operations, ensuring accurate clinical reviews, resolving complex cases, and assisting with team coaching and process improvements.

Key Responsibilities

• Provide clinical expertise and subject matter guidance to the Clinical Claims Operations team.

• Review and interpret medical records, clinical documentation, and claims-related 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.

Qualifications

• Must have an active and unrestricted USRN license.

• Bachelor's Degree in Nursing (BSN) is required.

• At least 2-3 years of US healthcare experience in any of the following:

  • Disability Claims

  • Clinical Claims Review

  • Utilization Management

  • Case Management

  • Workers' Compensation

  • Medical Review

  • Insurance Claims Operations

• Strong knowledge of medical terminology, clinical documentation, and US healthcare or insurance processes.

• Excellent analytical, communication, and problem-solving skills.

• With coaching, mentoring, or SME experience is an advantage.

• Proficient in Microsoft Office applications.

• Willing to work flexible or shifting schedules.

• Willing to work onsite in BGC, Taguig, with the opportunity to transition to WAH once the program stabilizes.