Senior Clinical Claims SME & Coach, USRN

SmartRecruiters, Inc.; Taguig; On-site; PHP 700,000 - 1,000,000; Full time

Job summary

Sutherland is seeking a licensed US Registered Nurse (USRN) to serve as the Subject Matter Expert and Clinical Claims Associate for disability and clinical claims operations in Taguig. The role combines hands-on claims review with SME guidance, coaching, and process governance to ensure quality and compliance.

The ideal candidate brings 2–3 years of US healthcare experience, strong clinical knowledge, and the ability to collaborate with operations leaders and client stakeholders while

Qualifications

• Active and unrestricted US Registered Nurse (USRN) license.
• Bachelor's Degree in Nursing (BSN).
• 2–3 years of US healthcare experience in disability/clinical claims.
• Strong English communication and MS Office skills.

Responsibilities

• Serve as the primary clinical SME for disability and clinical claims operations.
• Interpret and apply client-specific guidelines and policies.
• Review complex cases and provide recommendations to teams.
• Support production workers with coaching and real-time guidance.
• Maintain production workload while meeting productivity and quality targets.
• Balance SME duties with ongoing production responsibilities.
• Lead by example in claims processing and documentation.

Skills

USRN license

Clinical claims

Quality assurance

Coaching

English communication

Education

BSN

Tools

Microsoft Office

Job description

Sutherland is seeking a licensed US Registered Nurse (USRN) to serve as the Subject Matter Expert and Clinical Claims Associate for disability and clinical claims operations in Taguig. The role combines hands-on claims review with SME guidance, coaching, and process governance to ensure quality and compliance.

The ideal candidate brings 2–3 years of US healthcare experience, strong clinical knowledge, and the ability to collaborate with operations leaders and client stakeholders while