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SutherlandUSRN Subject Matter Expert (SME) - Clinical Claims Operations | 200k SOB
Sutherland is hiring an on-site USRN Subject Matter Expert (SME) for Clinical Claims Operations. This dual-role position functions both as a Subject Matter Expert and as…
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About This Role
Sutherland is hiring an on-site USRN Subject Matter Expert (SME) for Clinical Claims Operations. This dual-role position functions both as a Subject Matter Expert and as a Clinical Claims Associate. The individual will handle an assigned production workload while also offering real-time assistance, coaching, case consultations, and escalation management to production teams. The employer looks for a licensed professional capable of balancing individual case processing with peer support and process…
Job Description
Sutherland is hiring an on-site USRN Subject Matter Expert (SME) for Clinical Claims Operations. This dual-role position functions both as a Subject Matter Expert and as a Clinical Claims Associate. The individual will handle an assigned production workload while also offering real-time assistance, coaching, case consultations, and escalation management to production teams. The employer looks for a licensed professional capable of balancing individual case processing with peer support and process governance to maintain efficiency and accuracy.
The role suits a registered nurse with background in clinical claims or disability management who can collaborate with operations leaders, trainers, and quality teams. Responsibilities include interpreting client guidelines, reviewing medical documentation, maintaining compliance metrics, supporting onboarding, and leading continuous improvement initiatives. Candidates must be willing to work on a shifting schedule to meet business needs.
Responsibilities
- Serve as the primary clinical subject matter expert for disability and clinical claims operations
- Review complex cases and offer recommendations to associates and leadership
- Handle an assigned production workload while meeting quality, accuracy, and productivity metrics
- Provide real-time floor support, side-by-side coaching, and case reviews for agents
- Act as an escalation point for clinical and process-related questions
- Facilitate refresher training, uptraining programs, and onboarding support
- Partner with Quality Assurance teams on calibration sessions and audit activities
- Identify workflow improvement opportunities and participate in continuous improvement initiatives
Requirements
- Active and unrestricted US Registered Nurse license
- Bachelor of Science in Nursing
- Minimum of two to three years of US healthcare experience in disability claims, clinical claims review, utilization management, case management, workers' compensation, medical review, or insurance claims operations
- Extensive knowledge of disease processes, treatment protocols, medical terminology, and clinical documentation review
- Willingness to work a shifting schedule
- Ability to balance individual production responsibilities with SME support functions
Qualifications
- Experience working in a healthcare shared services or BPO environment
- Background supporting group benefits or disability claims accounts
- Exposure to Continuous Improvement or Lean Six Sigma
- Experience conducting coaching and training sessions
- Background in process calibration and quality auditing
- Project management or leadership 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 remote work policy for this role?
The source posting explicitly states that the role is on-site and requires willingness to work in a shifting schedule.
What are the core duties of the USRN Subject Matter Expert position?
The incumbent functions simultaneously as a Clinical Claims Associate and a Subject Matter Expert, managing a personal caseload while providing real-time coaching, floor support, escalation management, and process guidance to the team.
What license and educational background are required?
Applicants must hold an active and unrestricted US Registered Nurse license and a Bachelor's Degree in Nursing.
What is the salary for this position?
The posting does not specify a salary for the role.
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