Clinical Claims Quality Analyst - On-site QA & Compliance

Aitomic Jobs; Taguig; Hybrid; PHP 600,000 - 900,000; Full time

Job summary

Sutherland in the Philippines is seeking a Quality Analyst (Clinical Claims) to monitor, evaluate, and enhance the quality of clinical claim operations within the AO Clinical Claim Program.

You will ensure reviews, documentation assessments, and interactions meet client requirements and regulatory standards, partnering with Operations, Training, and Clinical Teams.

This role emphasizes continuous quality improvement, coaching, and calibration sessions to drive performance and compliance.

Qualifications

• Active USRN license.
• Minimum 2 years clinical experience in hospital or related healthcare settings.
• At least 1 year QA experience in a BPO/healthcare/claims environment.
• Strong knowledge of medical terminology and quality methodologies.

Responsibilities

• Monitor and improve quality of clinical claim operations.
• Conduct audits of claim reviews and related transactions.
• Provide feedback and support performance improvement plans.
• Prepare quality reports for operations and stakeholders.

Skills

Analytical skills

Coaching

Communication

Quality monitoring

Tools

Excel

PowerPoint

Job description

Sutherland in the Philippines is seeking a Quality Analyst (Clinical Claims) to monitor, evaluate, and enhance the quality of clinical claim operations within the AO Clinical Claim Program.

You will ensure reviews, documentation assessments, and interactions meet client requirements and regulatory standards, partnering with Operations, Training, and Clinical Teams.

This role emphasizes continuous quality improvement, coaching, and calibration sessions to drive performance and compliance.