Medical Insurance jobs

About Talents.Fit
Talents.Fit is a Philippines-based outsourcing company providing cost-effective HR and Employer of Record (EOR) services to businesses scaling their teams globally. We prioritize strong relationships with our clients, our internal teams, and the talents we support.

Role Overview

We are seeking an experienced Clinical Medical Records Review Specialist with a strong nursing or clinical healthcare background to support U.S. healthcare operations. This role is focused on reviewing and interpreting medical records, preparing accurate clinical summaries, and communicating directly with physician offices regarding medical records, billing inquiries, and procedural clarifications.

The ideal candidate is a confident healthcare professional with excellent clinical judgment, outstanding communication skills, and the ability to work independently. This is a front-end healthcare support role requiring someone who can engage professionally with physicians, medical staff, insurance representatives, and internal teams while ensuring the accuracy and completeness of clinical information.

Must-Have Requirements (Non-Negotiable)

• Nursing background or equivalent healthcare professional with strong clinical knowledge
• Ability to independently review medical records and prepare clear, accurate clinical summaries
• Strong understanding of medical terminology, clinical documentation, and healthcare workflows
• Excellent verbal and written English communication skills
• Confident communicating professionally with physicians, medical offices, insurance representatives, and internal teams
• Strong interpersonal skills with the ability to ask questions, clarify information, and lead professional conversations
• Self-starter with the ability to work independently and take ownership of assigned responsibilities
• Highly organized with excellent attention to detail and sound clinical judgment
• Experience in patient-facing or provider-facing healthcare environments
• Ability to identify clinically significant information within medical records
• Experience using EMR/EHR platforms such as Epic, Cerner, Allscripts, or similar systems
• Familiarity with Medicare, Medicaid, TRICARE, Workers' Compensation, and commercial insurance processes

Nice-to-Have

• Experience as a Medical Underwriter
• Claims Review or Claims Service Officer experience
• Familiarity with clinical decision support tools such as ODG, MCG, InterQual, Vitalware, VI Web, or MediWise
• Experience supporting U.S.-based healthcare organizations remotely
• Experience utilizing AI tools to improve documentation and workflow efficiency

Responsibilities

• Review and interpret medical records for completeness, accuracy, and clinical relevance
• Prepare concise, organized, and accurate medical record summaries for internal teams
• Identify clinically significant findings and communicate important information effectively
• Contact physician offices to obtain medical records, clarify documentation, and resolve billing or procedural questions
• Communicate confidently with healthcare providers, medical office staff, insurance representatives, and internal stakeholders
• Support healthcare operations by ensuring documentation is accurate, complete, and compliant
• Utilize AI-assisted tools where appropriate while validating all information using clinical expertise
• Maintain organized documentation and ensure timely completion of assigned tasks
• Exercise sound clinical judgment when reviewing records and escalating concerns when necessary

Working Hours

• Full-time
• U.S. working hours

Ideal Candidate

We're looking for someone who is:

• Clinically knowledgeable with strong critical thinking and analytical skills
• Confident speaking with physicians and other healthcare professionals
• Proactive, dependable, and able to work with minimal supervision
• Detail-oriented with a commitment to accuracy and quality
• Professional, organized, and solutions-oriented
• Comfortable taking ownership of tasks from start to finish
• An excellent communicator who can confidently gather, interpret, and relay complex medical information

Pay: Php25,000.00 - Php35,000.00 per month

Benefits:

• Additional leave
• Company Christmas gift
• Company events
• Opportunities for promotion
• Pay raise
• Promotion to permanent employee
• Work from home

Work Location: Remote