Opportunity at
SutherlandQuality Analyst (Clinical Claims) - Pooling
This pooled Manila role monitors quality in an AO clinical claims program at Sutherland. The quality analyst audits claim reviews and transactions against client guidelines, maintains…
Career Tools
About This Role
This pooled Manila role monitors quality in an AO clinical claims program at Sutherland. The quality analyst audits claim reviews and transactions against client guidelines, maintains scorecards, analyzes root causes, and gives feedback to associates and nurses to improve accuracy and compliance.
Job Description
This pooled Manila role monitors quality in an AO clinical claims program at Sutherland. The quality analyst audits claim reviews and transactions against client guidelines, maintains scorecards, analyzes root causes, and gives feedback to associates and nurses to improve accuracy and compliance.
Responsibilities
- Audit clinical claim reviews and related transactions
- Maintain quality scorecards and audit documentation
- Analyze quality trends and recommend corrective actions
- Give feedback to claims associates and nurses
Requirements
- Active and unrestricted US Registered Nurse license
- At least 2 years of recent clinical experience in a hospital, UM, case management or insurance setting
- At least 1 year as a Quality Analyst in BPO, healthcare, insurance or claims
Qualifications
- Lean Six Sigma Yellow Belt or equivalent quality certification
- Experience supporting disability or group benefits accounts
- Knowledge of disability or absence management programs
Core Skills
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this an on-site role?
Yes. The posting lists the job in Manila as on-site.
Is a US RN license needed?
Yes. An active and unrestricted US Registered Nurse license is required.
What internal qualifications apply?
Internal applicants need an Annual PDP score of Exceeds Expectations (4) or Outstanding (5), at least 12 months in the current role, and no active DA.
Sample Interview Questions
AI-generated questions tailored to this specific role — a preview of the full practice set.