Opportunity at
SutherlandUSRN Subject Matter Expert (SME) - Clinical Claims Operations
This Manila role is a dual position for a licensed US Registered Nurse acting as clinical subject matter expert for Sutherland's AO clinical claims program. The…
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About This Role
This Manila role is a dual position for a licensed US Registered Nurse acting as clinical subject matter expert for Sutherland's AO clinical claims program. The SME coaches production teams, interprets client guidelines, handles clinical escalations, and carries a personal claims workload that meets quality and productivity targets.
Job Description
This Manila role is a dual position for a licensed US Registered Nurse acting as clinical subject matter expert for Sutherland's AO clinical claims program. The SME coaches production teams, interprets client guidelines, handles clinical escalations, and carries a personal claims workload that meets quality and productivity targets.
Responsibilities
- Provide clinical expertise on claims and medical documentation review
- Coach associates through case reviews and side-by-side sessions
- Support refresher training and onboarding for new hires
- Take part in calibration sessions and corrective action plans
Requirements
- Active and unrestricted US Registered Nurse license
- Bachelor's degree in Nursing (BSN)
- 2-3 years of US healthcare experience in claims, utilization or case management
Qualifications
- Experience in a healthcare BPO or shared services environment
- Lean Six Sigma or continuous improvement exposure
- Experience facilitating training and coaching sessions
Core Skills
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this role on-site?
Yes. The posting lists it as an on-site position in Manila.
What license is required?
An active and unrestricted US Registered Nurse license is required.
Does the SME carry a caseload?
Yes. The role is dual, so the SME also maintains an assigned production workload alongside coaching and SME duties.
Sample Interview Questions
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