Clinical Claims SME & Floor Coach (USRN)

Sutherland; Taguig; On-site; PHP 900,000 - 1,600,000; Full time

Job summary

Sutherland in Taguig is seeking a licensed US Registered Nurse (USRN) to serve as the SME for clinical claims operations within the AO Clinical Claims Program. You will perform expert guidance, floor support, coaching, and case management while meeting productivity and quality targets.

The ideal candidate has 2–3 years US healthcare experience, strong analytical skills, and excellent English communication. Shifting schedules and cross-functional collaboration are required.

Qualifications

• Active and unrestricted USRN license.
• BSN degree in nursing.
• 2–3 years US healthcare experience in disability/clinical claims or related areas.
• Strong English communication and MS Office proficiency.
• Willing to work shifting schedules and balance SME duties.

Responsibilities

• Serve as the primary clinical SME for disability and clinical claims operations.
• Interpret and apply client-specific guidelines, medical policies and procedures.
• Review complex cases and provide recommendations to teams and leadership.
• Balance production workload with SME coaching and escalation support.
• Mentor colleagues on claims processing and documentation standards.
• Support quality and compliance initiatives and process governance.

Skills

USRN license

Analytical skills

English communication

Education

BSN

Tools

Microsoft Excel

Job description

Sutherland in Taguig is seeking a licensed US Registered Nurse (USRN) to serve as the SME for clinical claims operations within the AO Clinical Claims Program. You will perform expert guidance, floor support, coaching, and case management while meeting productivity and quality targets.

The ideal candidate has 2–3 years US healthcare experience, strong analytical skills, and excellent English communication. Shifting schedules and cross-functional collaboration are required.