Healthcare Claims Quality Analyst & Compliance Auditor

Sutherland; Pateros; On-site; PHP 400,000 - 650,000; Full time

Job summary

Sutherland is seeking a Quality Analyst to monitor, evaluate, and improve the quality of clinical claim operations within an AO Clinical Claim Program. The role ensures that claims reviews, medical documentation assessments, and customer interactions meet client requirements, regulatory standards, and internal quality expectations.

You will partner with Operations, Training, and Clinical Teams to identify improvement opportunities, provide actionable feedback, and drive continuous quality

Qualifications

• Active US Registered Nurse license (USRN).
• Minimum 2 years of recent clinical experience in hospital/utilization/clinical settings.
• At least 1 year of Quality Analyst experience in a BPO/healthcare/claims environment.
• Strong understanding of healthcare documentation and claim review processes.
• Proficiency in Microsoft Excel and PowerPoint.

Responsibilities

• Conduct regular quality audits of clinical claim reviews and related transactions.
• Maintain quality scorecards and audit documentation.
• Analyze quality trends, root causes, and performance gaps.
• Prepare and present quality reports to Operations leaders and stakeholders.
• Provide timely coaching and feedback to clinical staff and participate in calibration sessions.

Skills

Active USRN license

Nursing background

Quality monitoring

Analytical skills

Tools

Excel

PowerPoint

Job description

Sutherland is seeking a Quality Analyst to monitor, evaluate, and improve the quality of clinical claim operations within an AO Clinical Claim Program. The role ensures that claims reviews, medical documentation assessments, and customer interactions meet client requirements, regulatory standards, and internal quality expectations.

You will partner with Operations, Training, and Clinical Teams to identify improvement opportunities, provide actionable feedback, and drive continuous quality