Senior USRN Clinical Claims SME - Lead & Coach

Aitomic Jobs; Taguig; Hybrid; PHP 1,004,000 - 1,674,000; Full time

Job summary

Sutherland in Taguig, Philippines, is seeking a Subject Matter Expert – USRN to serve as the clinical and operational expert for the Clinical Claims Program. The role combines individual clinical claims work with SME support, coaching, and process improvement, requiring a licensed USRN with strong analytics and collaboration skills.

The ideal candidate will balance production with SME duties, support floor teams, and partner with Quality, Operations, and Training to maintain high standards.

Qualifications

• Active USRN license (unrestricted)
• BSN degree required
• 2–3 years US healthcare experience in Disability Claims / Clinical Claims Review / Utilization Management / Case Management / Workers' Compensation / Insurance Claims Operations
• Strong knowledge of medical terminology, clinical documentation review, disability management, and insurance claims processes

Responsibilities

• Perform end-to-end clinical claims review, assessment, and documentation to meet productivity, quality, accuracy, and compliance targets
• Serve as the SME for complex clinical and operational inquiries
• Provide floor support, coaching, case reviews, and real-time guidance to team members
• Support onboarding, uptraining, and knowledge management initiatives
• Collaborate with Quality, Operations, and Training to drive compliance and service excellence
• Identify process improvement opportunities and support implementation of best practices

Skills

Analytical skills

Communication skills

Coaching

Stakeholder management

Education

Bachelor's Degree in Nursing (BSN)

Tools

Microsoft Office

Job description

Sutherland in Taguig, Philippines, is seeking a Subject Matter Expert – USRN to serve as the clinical and operational expert for the Clinical Claims Program. The role combines individual clinical claims work with SME support, coaching, and process improvement, requiring a licensed USRN with strong analytics and collaboration skills.

The ideal candidate will balance production with SME duties, support floor teams, and partner with Quality, Operations, and Training to maintain high standards.