USRN Clinical Claims SME - Onsite Taguig, Flexible Hours

E-Solutions; Taguig; On-site; PHP 893,000 - 1,339,000; Full time

Job summary

E-Solutions is seeking a Clinical Claims SME with active US RN licensure to guide and support their US healthcare claims operations in Taguig. The role combines production work with SME coaching, documentation review, and escalation support.

The ideal candidate has a BSN and 2–3 years of US healthcare experience in disability, clinical claims review, case management, or workers’ compensation, and is willing to work onsite with eventual transition to work-from-home as the program stabilizes.

Qualifications

• Active and unrestricted US Registered Nurse license
• BSN degree required
• 2–3 years US healthcare experience in claims/clinical areas

Responsibilities

• Provide SME clinical guidance to Clinical Claims Operations team
• Review clinical documentation and claims-related information for accuracy and compliance
• Support escalations and complex claims issues with guidance
• Coach team members and share clinical knowledge
• Monitor performance and identify process improvement opportunities
• Collaborate with stakeholders to ensure efficient claims processing
• Balance production with SME support in a fast-paced environment

Skills

USRN license

BSN

Clinical claims

Coaching

Stakeholder management

Microsoft Office

Education

BSN

Tools

Microsoft Office

Job description

E-Solutions is seeking a Clinical Claims SME with active US RN licensure to guide and support their US healthcare claims operations in Taguig. The role combines production work with SME coaching, documentation review, and escalation support.

The ideal candidate has a BSN and 2–3 years of US healthcare experience in disability, clinical claims review, case management, or workers’ compensation, and is willing to work onsite with eventual transition to work-from-home as the program stabilizes.