Clinical Claims SME & Nurse Coach

SmartRecruiters, Inc.; Taguig; On-site; PHP 1,004,000 - 1,451,000; Full time

Job summary

Sutherland is seeking a licensed US Registered Nurse to serve as the clinical and operational SME for the Clinical Claims Program. This dual-role emphasizes managing a personal clinical claims workload while coaching the team, handling floor support, training, and process improvements.

The ideal candidate will collaborate with operations, quality, training, and client stakeholders. Requires USRN license, BSN, and 2–3 years of US healthcare experience in disability/clinical claims.

Qualifications

• Active US Registered Nurse (USRN) license.
• Bachelor's Degree in Nursing (BSN).
• Minimum 2-3 years of US healthcare experience in Disability Claims, Clinical Claims Review, Utilization Management, Case Management, Workers' Compensation, Medical Review, or Insurance Claims Operations.
• Strong knowledge of medical terminology, clinical documentation review, disability management, and insurance claims processes.
• Excellent analytical, communication, coaching, and stakeholder management skills.

Responsibilities

• Perform end-to-end clinical claims review, assessment, and documentation while meeting productivity, quality, accuracy, and compliance targets.
• Serve as the primary subject matter expert for complex clinical and operational inquiries.
• Provide floor support, coaching, case reviews, and real-time guidance to team members.
• Support onboarding, uptraining, and knowledge management initiatives.
• Partner with Quality, Operations, and Training teams to drive compliance, consistency, and service excellence.
• Identify process improvement opportunities and support implementation of best practices.
• Collaborate with internal stakeholders and client partners to address operational and clinical concerns.

Skills

Analytical skills

Stakeholder management

Coaching

Communication

Education

BSN

Tools

Microsoft Office

Job description

Sutherland is seeking a licensed US Registered Nurse to serve as the clinical and operational SME for the Clinical Claims Program. This dual-role emphasizes managing a personal clinical claims workload while coaching the team, handling floor support, training, and process improvements.

The ideal candidate will collaborate with operations, quality, training, and client stakeholders. Requires USRN license, BSN, and 2–3 years of US healthcare experience in disability/clinical claims.