USRN Clinical Claims SME & Training Coach

Sutherland; Taguig; On-site; PHP 1,000,000 - 1,600,000; Full time

Job summary

Sutherland is hiring a USRN-licensed Subject Matter Expert (SME) to serve as the clinical and operational resource for the AO Clinical Claims Program. This dual role combines clinical claims review with SME mentorship, coaching, and process governance to ensure quality, compliance, and efficiency.

The candidate will interpret client guidelines, review complex cases, and support production teams through training and real-time floor assistance in a fast-paced healthcare outsourcing environment.

Qualifications

• Active USRN license.
• BSN degree required.
• 2–3 years of US healthcare experience in disability or clinical claims review, utilization management, or case management.
• Strong knowledge of medical terminology and clinical documentation review.
• Excellent written and verbal English communication skills.
• Proficient in Microsoft Excel, Word, PowerPoint, and 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 associates and leadership.
• Support accurate evaluation and documentation of claims based on medical evidence.
• Ensure consistency in claims handling and decision-support processes.
• Perform end-to-end clinical claims review, assessment, and documentation activities.

Skills

US healthcare experience

USRN license

BSN

Clinical claims review

Analytical skills

English communication

MS Office

Education

BSN

Tools

MS Office

Job description

Sutherland is hiring a USRN-licensed Subject Matter Expert (SME) to serve as the clinical and operational resource for the AO Clinical Claims Program. This dual role combines clinical claims review with SME mentorship, coaching, and process governance to ensure quality, compliance, and efficiency.

The candidate will interpret client guidelines, review complex cases, and support production teams through training and real-time floor assistance in a fast-paced healthcare outsourcing environment.