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SutherlandSubject Matter Expert (SME) - USRN - Taguig
Sutherland is hiring a Subject Matter Expert (SME) - USRN to join the AO Clinical Claims Program based in Taguig. This dual-role position functions simultaneously as…
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About This Role
Sutherland is hiring a Subject Matter Expert (SME) - USRN to join the AO Clinical Claims Program based in Taguig. This dual-role position functions simultaneously as a Clinical Claims Associate and a Subject Matter Expert, requiring the incumbent to handle an independent production workload while delivering real-time coaching, floor support, and process governance to the operations team. The role suits a licensed healthcare professional who can balance case processing responsibilities…
Job Description
Sutherland is hiring a Subject Matter Expert (SME) - USRN to join the AO Clinical Claims Program based in Taguig. This dual-role position functions simultaneously as a Clinical Claims Associate and a Subject Matter Expert, requiring the incumbent to handle an independent production workload while delivering real-time coaching, floor support, and process governance to the operations team.
The role suits a licensed healthcare professional who can balance case processing responsibilities with guiding peers, facilitating training, partnering with quality assurance teams, and supporting continuous improvement initiatives. The candidate will interpret client-specific guidelines, review complex medical documentation, handle escalations, and maintain performance metrics. Ideal applicants possess a background in US healthcare settings, excellent communication skills, and the capacity to adapt to shifting schedules.
Responsibilities
- Serve as the primary clinical subject matter expert for disability and clinical claims operations
- Review complex cases and provide clinical recommendations to colleagues and leaders
- Maintain an assigned individual production workload and meet established productivity, quality, accuracy, and compliance targets
- Deliver floor support, side-by-side coaching, and real-time assistance to agents and analysts
- Act as the escalation point for clinical and process-related questions
- Facilitate refresher sessions, uptraining programs, and onboarding activities
- Partner with quality assurance teams to drive accuracy and participate in calibration sessions
- Identify workflow inefficiencies and collaborate on continuous improvement initiatives
Requirements
- Active and unrestricted US Registered Nurse (USRN) license
- Bachelor's Degree in Nursing (BSN)
- Minimum of 2 to 3 years of US healthcare experience in disability claims, clinical claims review, utilization management, case management, workers' compensation, medical review, or insurance claims operations
- Strong knowledge of medical terminology, disease processes, treatment protocols, and clinical documentation review
- Proficiency in Microsoft Office applications including Excel, Word, PowerPoint, and Outlook
- Willingness to work in a shifting schedule
Qualifications
- Experience working in a healthcare BPO or shared services environment
- Experience supporting disability claims, group benefits, or similar insurance accounts
- Exposure to Lean Six Sigma or continuous improvement methodologies
- Background in quality auditing and process calibration
- Prior leadership or project management experience
Core Skills
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
What is the location of this job?
The position is based in Taguig.
What are the core duties of this role?
This is a dual-role position where you must independently process clinical claims while simultaneously serving as a Subject Matter Expert providing coaching, floor support, training assistance, and escalation management.
What license and education are required to apply?
Applicants must hold an active and unrestricted US Registered Nurse (USRN) license and a Bachelor's Degree in Nursing.
What is the salary for this position?
The salary is not specified in the job posting.
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