Team Manager | AO Clinical Claims

Sutherland; Taguig; On-site; PHP 1,004,000 - 2,009,000; Full time

Job summary

Sutherland in the Philippines is seeking a Team Manager for its USRN Clinical Claims operation, leading a team of Clinical Claims Associates/Specialists handling Accident & Occupational claims. You will drive performance and ensure quality outcomes aligned with client metrics and regulatory standards.

You will coach staff, manage performance reviews, and oversee daily operations to maintain accuracy and timely processing, while promoting continuous improvement and strong client relationships.

Qualifications

• Active and unrestricted US Registered Nurse (USRN) license.
• Bachelor's Degree in Nursing (BSN) or equivalent.
• Minimum 3–5 years of clinical nursing experience in healthcare settings.
• Minimum 2 years of people management experience leading healthcare operations or claims teams.
• Strong understanding of medical terminology and healthcare processes.
• Excellent verbal and written English communication.
• Strong analytical, coaching, and stakeholder management skills.

Responsibilities

• Lead a team of USRN Clinical Claims Associates/Specialists.
• Ensure achievement of productivity, quality, accuracy, and turnaround targets.
• Coach and develop team members; conduct performance reviews.
• Maintain HIPAA/data privacy compliance and client standards.
• Manage attendance, engagement, and retention; foster high performance.

Skills

USRN license

BSN

Clinical nursing

People management

English communication

Analytical skills

Education

Bachelor's Degree in Nursing (BSN)

Job description

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Job Description

The Team Manager is responsible for leading a team of USRN Clinical Claims Associates/Specialists supporting Accident & Occupational (AO) Clinical Claims operations. The role will drive operational excellence by ensuring achievement of client metrics, quality standards, service levels, productivity targets, compliance requirements, and employee engagement objectives.

The Team Manager will provide coaching, performance management, clinical guidance, and day-to-day operational leadership to ensure accurate claims processing and exceptional customer outcomes while maintaining regulatory and client standards.

Key Responsibilities

Operations Management

• Manage the daily operations of assigned clinical claims teams.
• Monitor and ensure achievement of productivity, quality, accuracy, compliance, and turnaround time targets.
• Analyze performance trends and implement action plans to address gaps.
• Ensure adherence to client processes, policies, and standard operating procedures.
• Support the achievement of account and business objectives.
• Lead, coach, and develop a team of Clinical Claims Associates/Specialists.
• Conduct regular performance reviews, coaching sessions, and career development discussions.
• Manage attendance, adherence, employee engagement, and retention initiatives.
• Create and maintain a high-performance culture focused on accountability and continuous improvement.
• Handle employee relations matters in partnership with HR and Operations leadership.

Quality & Compliance

• Ensure compliance with HIPAA, data privacy, client requirements, and regulatory standards.
• Conduct audits and reviews to ensure claims are processed accurately and consistently.
• Drive corrective and preventive action plans for identified performance gaps.
• Promote adherence to clinical documentation and claims adjudication standards.

Client Management

• Support Operations Leadership during business reviews and client discussions.
• Provide timely updates and insights regarding team performance.
• Participate in calibration sessions and process improvement initiatives.
• Maintain strong client relationships through consistent delivery of operational commitments.
• Identify opportunities to improve workflows, productivity, and quality outcomes.
• Lead process improvement projects and change management initiatives.
• Drive knowledge-sharing and best-practice implementation across teams.

Qualifications

Minimum Qualifications

• Active and unrestricted US Registered Nurse (USRN) license.
• Bachelor's Degree in Nursing (BSN) or equivalent nursing qualification.
• Minimum 3-5 years of clinical nursing experience in a hospital, healthcare, insurance, disability claims, utilization review, case management, or related healthcare setting.
• Minimum 2 years of people management experience leading healthcare operations, clinical teams, BPO healthcare accounts, or claims operations.
• Strong understanding of medical terminology, clinical documentation, and healthcare processes.
• Excellent verbal and written English communication skills.
• Strong analytical, coaching, and stakeholder management skills.

Preferred Qualifications

• Experience in:
  • Disability Claims Management
  • Clinical Claims Review
  • Utilization Management
  • Case Management
  • Health Insurance Operations
  • Healthcare BPO Operations
• Experience managing US healthcare or insurance accounts.
• Lean Six Sigma, Quality, or Process Improvement certification is an advantage.
• Knowledge of HIPAA and healthcare compliance requirements.

Experience handling client-facing operational reviews and presentations.

Additional Information

Internal Qualifications:

• Must have Annual PDP score of Exceeds Expectations (4) or Outstanding (5)
• Tenure of at least 18 months on the current role
• No Active DA