Clinical Quality Analyst - Elevate Healthcare Claims

Sutherland

Pateros

On-site

PHP 350,000 - 550,000

Full time

4 days ago

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Job summary

Sutherland in the Philippines is seeking a Quality Analyst to monitor, evaluate, and improve the quality of clinical claim operations within the AO Clinical Claim Program. You will work with Operations, Training, and Clinical Teams to identify improvements and drive quality excellence.

The role requires an active USRN license, 2+ years clinical experience, and 1+ year QA experience in healthcare/claims. Strong auditing, analytics, and communication skills are essential, with a focus on

Qualifications

Active and unrestricted US Registered Nurse (USRN) license.
Minimum 2 years of recent clinical experience in healthcare settings.
At least 1 year of Quality Analyst experience in a BPO/healthcare/claims environment.
Strong understanding of healthcare documentation and claim review processes.
Knowledge of quality methodologies, auditing principles, and root cause analysis.
Excellent analytical, coaching, and communication skills.

Responsibilities

Monitor, evaluate, and improve the quality of clinical claim operations.
Maintain quality scorecards and audit documentation.
Analyze quality trends, root causes, and performance gaps; present findings to leaders.
Provide feedback and develop performance improvement plans with managers.
Ensure HIPAA compliance and adherence to client policies and internal standards.
Collaborate with Operations, Training, and Client Services teams.