Clinical Claims SME & Process Improvement

Sutherland Global; Taguig; Hybrid; PHP 600,000 - 1,000,000; Full time

Job summary

Sutherland Global is seeking a licensed US Registered Nurse (USRN) to serve as the clinical and operational SME for the AO Clinical Claims Program in the Philippines. The role focuses on clinical claims processes, documentation review, and policy compliance, with coaching and process governance to ensure service excellence.

The ideal candidate has 2–3 years of US healthcare experience, strong analytical skills, and the ability to collaborate with operations leaders, quality teams, trainers, and

Qualifications

• Active USRN license and BSN required.
• 2-3 years of US healthcare experience in disability or clinical claims.
• Strong analytical and English communication skills.

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.
• Support accurate evaluation and documentation of clinical claims based on medical evidence and established protocols.
• Ensure consistency in claims handling and decision-support processes.
• Provide floor support and real-time assistance to agents and analysts.

Skills

USRN license

US healthcare exp

Analytical thinking

English communication

Shift work willingness

Education

BSN

Tools

Excel

Word

PowerPoint

Outlook

Job description

Sutherland Global is seeking a licensed US Registered Nurse (USRN) to serve as the clinical and operational SME for the AO Clinical Claims Program in the Philippines. The role focuses on clinical claims processes, documentation review, and policy compliance, with coaching and process governance to ensure service excellence.

The ideal candidate has 2–3 years of US healthcare experience, strong analytical skills, and the ability to collaborate with operations leaders, quality teams, trainers, and