USRN Subject Matter Expert
Save this job and keep your search organized
Create a free account to save jobs, create alerts and return to this listing from your dashboard.
By continuing, you agree to our Terms & Privacy Policy.
About the role
The USRN Subject Matter Expert (SME) serves as the clinical and operational resource for the AO Clinical Claims Program. This role provides expertise on clinical claims processes, medical documentation review, disability management guidelines, quality standards, and client-specific policies and procedures. The SME supports production teams through coaching, training, case consultations, quality improvement initiatives, and process governance to ensure service excellence, compliance, and operational efficiency. This is a dual-role position that requires the incumbent to function both as a Clinical Claims Associate and as a Subject Matter Expert simultaneously. In addition to providing expert guidance, floor support, coaching, and process expertise, the SME is expected to independently perform the same core clinical claims review and case management responsibilities as other team members.
Key responsibilities
- Serve as the primary clinical subject matter expert for disability and clinical claims operations
- Interpret and apply client-specific guidelines, medical policies, and standard operating procedures
- Review complex cases and provide recommendations to associates and leadership teams
- Support accurate evaluation and documentation of clinical claims based on medical evidence and established protocols
- Ensure consistency in claims handling and decision-support processes
- Perform end-to-end clinical claims review, assessment, and documentation activities consistent with the responsibilities of a Clinical Claims Associate/Analyst
- Maintain an assigned production workload and achieve established productivity, quality, accuracy, and compliance targets
- Provide floor support and real-time assistance to agents and analysts
- Conduct case reviews, side-by-side coaching, and knowledge-sharing sessions
- Facilitate refresher sessions and uptraining programs
About you
- Active and unrestricted US Registered Nurse (USRN) license
- Bachelor's Degree in Nursing (BSN)
- Minimum 2-3 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 medical terminology, disease processes, treatment protocols, and clinical documentation review
- Strong understanding of disability management and insurance claims processes
- Strong analytical and critical-thinking skills
- Excellent written and verbal English communication skills
- Proficient in Microsoft Office applications, particularly Excel, Word, PowerPoint, and Outlook
- Demonstrated ability to effectively balance individual production responsibilities with Subject Matter Expert support functions
- Strong time management, prioritization, multitasking, and stakeholder management skills in a fast-paced clinical operations environment
-
USRN Subject Matter Expert
3 days ago
Taguig, Metro Manila, Philippines Sutherland Full-timeAbout Sutherland Artificial Intelligence. Automation. Cloud engineering. Advanced analytics. For business leaders, these are key factors of success. For us, they’re our core expertise. We work with iconic brands worldwide. We bring them a unique value proposition through market-leading technology and business process excellence. We’ve created over 200...
-
USRN Subject Matter Expert
3 days ago
Taguig, Metro Manila, Philippines Aitomic Jobs Full-timeShort Summary USRN Subject Matter Expert (SME) – Clinical Claims Operations with Sutherland. Job Summary The Subject Matter Expert (SME) serves as the clinical and operational resource for the AO Clinical Claims Program. This role provides expertise on clinical claims processes, medical documentation review, disability management guidelines, quality...
-
Subject Matter Expert – USRN
3 days ago
Taguig, Metro Manila, Philippines Aitomic Jobs Full-time ₱1 - ₱2 ContractShort Summary Subject Matter Expert – USRN with Sutherland. Job Summary The SME serves as the clinical and operational expert for the Clinical Claims Program, providing guidance on claims processes, medical documentation review, disability management, quality standards, and client-specific procedures. This is a dual-role position requiring the incumbent to...
-
Subject Matter Expert
2 days ago
Taguig, Metro Manila, Philippines Sutherland Global Full-timeCompany Description: About Sutherland Artificial Intelligence. Automation. Cloud engineering. Advanced analytics. For business leaders, these are key factors of success. For us, they’re our core expertise.We work with iconic brands worldwide. We bring them a unique value proposition through market-leading technology and business process excellence. We’ve...
-
Subject Matter Expert
2 days ago
Taguig, Metro Manila, Philippines Sutherland Full-timeSubject Matter Expert (SME) - USRN - Taguig Full-time About Sutherland Artificial Intelligence. Automation. Cloud engineering. Advanced analytics. For business leaders, these are key factors of success. For us, they’re our core expertise.We work with iconic brands worldwide. We bring them a unique value proposition through market-leading technology and...
-
Taguig, Metro Manila, Philippines Cognizant Full-timeAbout the Role We are looking for a Subject Matter Expert (SME) with experience in Non-Life Insurance and a BPO/Contact Center environment to support a Property & Casualty insurance account. What We're Looking For ✅ Non-Life Insurance experience (Property & Casualty, Auto, Home Insurance) ✅ BPO / Contact Center experience ✅ Background in policy...
-
Subject Matter Expert
3 days ago
Taguig, Metro Manila, Philippines Aitomic Jobs Full-timeShort Summary Subject Matter Expert (SME) – USRN – Taguig with Sutherland. Job Summary The Subject Matter Expert (SME) serves as the clinical and operational resource for the AO Clinical Claims Program. This role provides expertise on clinical claims processes, medical documentation review, disability management guidelines, quality standards, and...
-
Subject Matter Expert
3 days ago
Taguig, Metro Manila, Philippines Merck Group Full-timeWork Your Magic with us! Ready to explore, break barriers, and discover more? We know you’ve got big plans – so do we! Our colleagues across the globe love innovating with science and technology to enrich people’s lives with our solutions in Healthcare, Life Science, and Electronics. Together, we dream big and are passionate about caring for our rich...
-
Subject Matter Expert, Accounting to Reporting
5 hours ago
Taguig, Metro Manila, Philippines Fresenius Medical Care Full-timeThe ATR Subject Matter Expert has extensive knowledge and specialization of Record to Report process(es). They provides organizational support for daily operations, delegation and review of work, delivers training, technical and/or operational guidance to others, when needed, under limited supervision of the Supervisor. Responsibilities Develop and...
-
Infrastructure Subject Matter Expert
5 hours ago
Taguig, Metro Manila, Philippines Questronix Corporation Full-timeKey Characteristics/Behaviors: Punctual - needs to be onsite everday following CB core hours; flexible - sometimes need to do OT, shifting or weekend work as needed Well-rounded - understands various Infra (e.g. network, middleware, servers, etc) Analytic/Logical thinking - can do thorough analysis/investigation to determine event triggers and scenarios;...
