USRN Clinical Claims SME & Operations Lead

Aitomic Jobs; Taguig; Hybrid; PHP 600,000 - 1,000,000; Full time

Job summary

Sutherland is seeking a USRN Subject Matter Expert (SME) for Clinical Claims Operations in Taguig, Philippines. The role combines clinical claims review with SME responsibilities to support production teams through coaching, training, and process governance.

A licensed USRN with solid claims experience and analytical skills is required to ensure service excellence, compliance, and operational efficiency in a demanding environment.

Qualifications

• Licensed US Registered Nurse (USRN) with strong clinical claims experience.
• Analytical thinking and ability to collaborate with operations leaders, quality teams, trainers, and client stakeholders.

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 associates and leadership.
• Support accurate evaluation and documentation of clinical claims based on medical evidence.
• Ensure consistency in claims handling and decision-support processes.
• Perform end-to-end clinical claims review and documentation while managing a production workload.

Job description

Sutherland is seeking a USRN Subject Matter Expert (SME) for Clinical Claims Operations in Taguig, Philippines. The role combines clinical claims review with SME responsibilities to support production teams through coaching, training, and process governance.

A licensed USRN with solid claims experience and analytical skills is required to ensure service excellence, compliance, and operational efficiency in a demanding environment.