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Nurse - Group Insurance Claims


Portland, ME
Job Code:
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Job Details

Position Title: Nurse - Group Insurance Claims
Job Code: 430578
Job Location: Maine-Portland

The Clinician will be responsible for the following:

  • Assists claims managers in managing claims by reviewing medical information to determine disability status, appropriateness of care, and help develop customized RTW plans.
  • Develops action plans for case resolution and for facilitation of appropriate claim decisions including implementation of obtaining additional medical documentation.
  • Actively intervenes with claimants and health care providers for initial information, status and clarification.
  • Determines the requirements for additional information/documentation including:  Medical records, job descriptions, and additional medical authorization if necessary. 
  • Formulates correspondence and questions for both providers and IMEs and includes appropriate documentation.
  • Determines disposition or next steps in continued case management for the Disability Claim Manager.

  • College degree in nursing preferred
  • Minimum of 2 years hospital experience preferred (Emergency Room Critical Care, Orthopedics, Adult Medical or Surgical or Psychiatric)
  • Experience in Disability Case Management, Occupational Health Nursing, or Workers Compensation preferred
  • Excellent oral and written communication and critical thinking skills required
  • Computer skills including Windows required

Prudential is a multinational financial services leader with operations in the United States, Asia, Europe, and Latin America. Leveraging its heritage of life insurance and asset management expertise, Prudential is focused on helping individual and institutional customers grow and protect their wealth. The company's well-known Rock symbol is an icon of strength, stability, expertise and innovation that has stood the test of time. Prudential's businesses offer a variety of products and services, including life insurance, annuities, retirement-related services, mutual funds, asset management, and real estate services.

We recognize that our strength and success are directly linked to the quality and skills of our diverse associates. We are proud to be a place where talented people who want to make a difference can grow as professionals, leaders, and as individuals. Visit to learn more about our values, our history and our brand.

Prudential is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, genetics, disability, age, veteran status, or any other characteristic protected by law.

Note that this posting is intended for individual applicants. Search firms or agencies should email Staffing at for more information about doing business with Prudential.
Job Function: Claims
Schedule: Full-time
Apply on the Company Site
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