Subject Matter Expert (SME) - USRN - Taguig

Sutherland
Philippines
Workplace: OnsiteFull timeFunction: Design (Product/UX/UI/Visual)Experience: 2-3 yearsEducation: bachelorsSkills: ["Analytical skills","Critical-thinking","Communication","Coaching","Stakeholder management"]

Serve as the primary clinical SME for disability and clinical claims operations, interpreting client guidelines and reviewing complex cases using established medical policies and protocols. Maintain an assigned production workload while providing floor support, escalation handling, coaching, and knowledge-sharing to associates and analysts. Drive quality and compliance through calibration, QA partnership, audit support, and process governance, while monitoring regulatory/client changes and implementing continuous improvement initiatives.

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FursaFursa
Sutherland
Sutherland
2 days ago

Subject Matter Expert (SME) - USRN - Taguig

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Last checked: 6 hours agoStatus: Live

Job Summary

Serve as the primary clinical SME for disability and clinical claims operations, interpreting client guidelines and reviewing complex cases using established medical policies and protocols. Maintain an assigned production workload while providing floor support, escalation handling, coaching, and knowledge-sharing to associates and analysts. Drive quality and compliance through calibration, QA partnership, audit support, and process governance, while monitoring regulatory/client changes and implementing continuous improvement initiatives.
Location: Philippines
Workplace: Onsite
Employment Type: Full time
Job Function: Design (Product/UX/UI/Visual)
Seniority: Mid level

Key Responsibilities

  • •Serve as the primary clinical subject matter expert for disability and clinical claims operations, interpreting client guidelines and reviewing complex cases.
  • •Perform end-to-end clinical claims review, assessment, and documentation while maintaining an assigned production workload and meeting productivity/quality/compliance metrics.
  • •Provide floor support with real-time assistance, case reviews, side-by-side coaching, escalation handling, and knowledge-sharing.
  • •Partner with Quality Assurance to drive accuracy and compliance, participate in calibration sessions, and support audit activities and corrective action plans.
  • •Lead process improvement by identifying workflow and claims review opportunities, analyzing trends/defects, collaborating on continuous improvement initiatives, and supporting implementations.

Key Requirements

  • •Active and unrestricted US Registered Nurse (USRN) license.
  • •Bachelor's Degree in Nursing (BSN).
  • •Minimum 2-3 years of US healthcare experience in one or a combination of disability claims, clinical claims review, utilization management, case management, workers' compensation, medical review, or insurance claims operations.
  • •Extensive knowledge of medical terminology, disease processes, treatment protocols, and clinical documentation review.
  • •Strong analytical skills and excellent written and verbal English communication skills.
Experience:2-3 yearsHealthcareDisability claimsInsurance claims
Education:Bachelor's in Nursing
Skills:Analytical skillsCritical-thinkingCommunicationCoachingStakeholder management
Licenses:US Registered Nurse (USRN)
Languages:English
Tech Stack:Microsoft OfficeExcelWordPowerPointOutlook

Company Brief

Sutherland
Global digital transformation and business process services firm offering AI, automation, cloud engineering, analytics and customer experience solutions to enterprises across industries.
Industry: Professional Services
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Established Company
Funding: Private Equity Backed
Headquarters: Pittsford (Rochester), NY, United States
Founded: 1986
Glassdoor
Glassdoor: 3.5
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