USRN Clinical Claims SME & Coach

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

Job summary

Join Sutherland in the Philippines as a Subject Matter Expert (SME) for Clinical Claims. This dual-role position blends Clinical Claims Associate responsibilities with SME guidance, balancing case management with coaching and process governance.

The ideal candidate is a US-licensed RN with strong claims experience and analytical skills. You will collaborate with operations leaders, QA, trainers, and client stakeholders to ensure compliant, high-quality service delivery and continual process

Qualifications

• Active and unrestricted US Registered Nurse (USRN) license.
• Bachelor's Degree in Nursing (BSN).
• Minimum 2–3 years of US healthcare experience in Disability Claims, Clinical Claims Review, UM, CM, Workers' Compensation, Medical Review or Insurance Claims Operations.
• Extensive knowledge of medical terminology, disease processes and clinical documentation review.
• Strong understanding of disability management and insurance claims processes.
• Experience in healthcare BPO/shared services is preferred.
• Strong analytical and critical-thinking skills.
• Excellent written and verbal English communication skills.
• Proficient with Microsoft Office applications; Excel, Word, PowerPoint, Outlook.

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 and leadership.
• Support accurate evaluation and documentation of clinical claims based on medical evidence.
• Balance production targets with SME coaching and escalation support.
• Provide floor support and real-time assistance to agents and analysts.
• Lead training and knowledge management activities; update process docs.

Skills

US healthcare experience

Clinical claims review

Analytical skills

English communication

Time management

Education

BSN

Nursing degree

Tools

Microsoft Excel

Microsoft Word

PowerPoint

Outlook

Job description

Join Sutherland in the Philippines as a Subject Matter Expert (SME) for Clinical Claims. This dual-role position blends Clinical Claims Associate responsibilities with SME guidance, balancing case management with coaching and process governance.

The ideal candidate is a US-licensed RN with strong claims experience and analytical skills. You will collaborate with operations leaders, QA, trainers, and client stakeholders to ensure compliant, high-quality service delivery and continual process