Clinical Quality Analyst | RN, HIPAA & QA Excellence

Sutherland; Taguig; On-site; PHP 300,000 - 600,000; Full time

Job summary

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

The role requires a USRN license, 2+ years of clinical experience, and 1+ year in a QA role within healthcare or BPO environments. Strong analytical and communication skills are essential.

Qualifications

• Active and unrestricted US Registered Nurse (USRN) license.
• Minimum 2 years of recent clinical experience in hospital, utilization management, case management, disability, health insurance, or related healthcare settings.
• At least 1 year of Quality Analyst experience in a BPO, healthcare, insurance, claims, or clinical operations environment.
• Strong understanding of healthcare documentation, claim review processes, and medical terminology.
• Knowledge of quality methodologies, auditing principles, and root cause analysis.
• Excellent analytical, coaching, and communication skills.
• Experience in performance monitoring, quality scorecards, and reporting.
• Proficiency in Microsoft Excel and PowerPoint.

Responsibilities

• Monitor, evaluate, and improve the quality of clinical claim operations.
• Audit clinical claim reviews and related transactions.
• Maintain quality scorecards and audit documentation.
• Analyze quality trends, root causes, and performance gaps.
• Provide actionable feedback and drive continuous quality improvement.
• Collaborate with Operations, Training, and Clinical Teams.
• Ensure HIPAA compliance and regulatory adherence.
• Prepare quality reports for Operations leaders and stakeholders.

Skills

Analytical skills

Communication skills

Coaching abilities

Independent working

Education

USRN license

Tools

Excel

PowerPoint

Job description

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

The role requires a USRN license, 2+ years of clinical experience, and 1+ year in a QA role within healthcare or BPO environments. Strong analytical and communication skills are essential.