RN SME - Clinical Claims & Process Coach

Sutherland; Pateros; On-site; PHP 800,000 - 1,100,000; Full time

Job summary

Sutherland in the Philippines seeks a licensed US Registered Nurse (USRN) to serve as the SME for the AO Clinical Claims Program. The role covers clinical claims review, disability management guidelines, and client-specific policies, with coaching and process governance to ensure compliance and efficiency.

This dual-role position combines Clinical Claims Associate responsibilities with SME guidance, maintaining a personal caseload while meeting productivity and quality targets.

Qualifications

• Active and unrestricted USRN license.
• Bachelor’s Degree in Nursing (BSN).
• 2–3 years US healthcare experience in disability/clinical claims.
• Strong analytical and English communication skills.
• Experience with healthcare BPO/shared services preferred.

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 teams.
• Balance personal caseload with SME support and escalation management.
• Provide floor support, coaching, and training as needed.
• Support process improvements and maintain quality/compliance metrics.

Skills

US healthcare experience

Clinical claims review

Analytical skills

English communication

Excel proficiency

Coaching & mentorship

Education

BSN degree

USRN license

Tools

Excel

Word

PowerPoint

Job description

Sutherland in the Philippines seeks a licensed US Registered Nurse (USRN) to serve as the SME for the AO Clinical Claims Program. The role covers clinical claims review, disability management guidelines, and client-specific policies, with coaching and process governance to ensure compliance and efficiency.

This dual-role position combines Clinical Claims Associate responsibilities with SME guidance, maintaining a personal caseload while meeting productivity and quality targets.