RN Clinical Claims SME & Coaching Lead

Sutherland; Taguig; On-site; PHP 800,000 - 1,200,000; Full time

Job summary

Sutherland seeks a licensed US Registered Nurse (USRN) to fill a dual Role: Clinical Claims Associate and Subject Matter Expert (SME) for the AO Clinical Claims Program. You will provide expert guidance, floor support, and real-time coaching, while independently performing core clinical claims review and case management tasks.

The ideal candidate has strong clinical claims experience, analytical skills, and collaborates with operations, quality teams, trainers, and client stakeholders.

Qualifications

• Active US Registered Nurse (USRN) license.
• Bachelor of Science in Nursing (BSN).
• Minimum 2–3 years of US healthcare experience in disability/clinical claims, utilization management, case management, workers' compensation, or medical review/insurance claims operations.
• Strong knowledge of medical terminology, disease processes, and clinical documentation review.
• Excellent written and verbal English communication skills.
• Proficiency in Microsoft Office applications (Excel, Word, PowerPoint, Outlook).
• Willing to work in a shifting schedule and support business requirements.

Responsibilities

• Serve as the primary clinical SME for disability and clinical claims operations.
• Interpret and apply client guidelines, medical policies, and SOPs.
• Review complex cases and provide recommendations to teams and leadership.
• Support accurate evaluation and documentation of clinical claims.
• Ensure consistency in claims handling and decision-support processes.
• Balance production workload with SME coaching and escalation duties.

Skills

USRN license

English communication

MS Office

Coaching

Quality monitoring

Education

BSN degree

Tools

Excel

Word

PowerPoint

Outlook

Job description

Sutherland seeks a licensed US Registered Nurse (USRN) to fill a dual Role: Clinical Claims Associate and Subject Matter Expert (SME) for the AO Clinical Claims Program. You will provide expert guidance, floor support, and real-time coaching, while independently performing core clinical claims review and case management tasks.

The ideal candidate has strong clinical claims experience, analytical skills, and collaborates with operations, quality teams, trainers, and client stakeholders.