USRN Clinical Claims SME: Disability & Quality Coach

Sutherland; Pateros; On-site; PHP 4,708,000 - 5,964,000; Full time

Job summary

Sutherland seeks a licensed US Registered Nurse (USRN) to serve as the SME for clinical claims within the AO Clinical Claims Program. The role combines clinical review, policy interpretation, and production accountability to ensure accuracy and compliance.

In this dual-role, you will coach and support production teams while managing a personal caseload and maintaining high quality metrics. Strong coordination with stakeholders is essential.

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 knowledge of medical terminology and claims processes.
• Excellent written and verbal English communication.

Responsibilities

• Serve as primary clinical SME for disability and clinical claims operations.
• Interpret client guidelines and apply medical policies and procedures.
• Review complex cases and provide recommendations to teams.
• Maintain production workload and meet productivity and quality targets.
• Provide floor support, coaching, and escalation management.
• Collaborate with Operations Managers, Quality Analysts, and Trainers.
• Support training, knowledge management, and process documentation.

Skills

USRN license

Clinical claims analytics

English communication

Time management

Coaching & floor support

Microsoft Office

Education

BSN

Tools

Excel

Word

PowerPoint

Outlook

Job description

Sutherland seeks a licensed US Registered Nurse (USRN) to serve as the SME for clinical claims within the AO Clinical Claims Program. The role combines clinical review, policy interpretation, and production accountability to ensure accuracy and compliance.

In this dual-role, you will coach and support production teams while managing a personal caseload and maintaining high quality metrics. Strong coordination with stakeholders is essential.