Clinical Claims SME & Coach (RN)

Sutherland Global; Taguig; On-site; PHP 893,000 - 1,339,000; Full time

Job summary

Sutherland Global is seeking a licensed US Registered Nurse (USRN) for a dual role as Clinical Claims Associate and Subject Matter Expert in the AO Clinical Claims Program. You will guide clinical claims reviews, ensure compliance, and coach production teams while balancing a personal caseload.

The ideal candidate brings strong clinical claims experience, analytical skills, and the ability to collaborate with operations leaders, quality teams, and client stakeholders.

Qualifications

• Active and unrestricted US Registered Nurse (USRN) license is required.
• Bachelor’s degree in Nursing (BSN) is required.
• Minimum 2–3 years of US healthcare experience in disability/clinical claims review or related areas.

Responsibilities

• Serve as the primary clinical SME for disability and clinical claims operations.
• Interpret and apply client-specific guidelines, medical policies, and SOPs.
• Review complex cases and provide recommendations to associates and leadership.
• Maintain production workload while providing SME support and coaching.

Skills

USRN license

Clinical claims experience

Analytical thinking

Coaching skills

English communication

Education

BSN

Tools

MS Office

Excel

Job description

Sutherland Global is seeking a licensed US Registered Nurse (USRN) for a dual role as Clinical Claims Associate and Subject Matter Expert in the AO Clinical Claims Program. You will guide clinical claims reviews, ensure compliance, and coach production teams while balancing a personal caseload.

The ideal candidate brings strong clinical claims experience, analytical skills, and the ability to collaborate with operations leaders, quality teams, and client stakeholders.