Subject Matter Expert (SME) - USRN - Taguig

Location: Taguig, Philippines

Company

Technology and business process services provider specializing in artificial intelligence, automation, cloud engineering, advanced analytics, and business process excellence.

What you will do

• Serve as the clinical subject matter expert for disability and clinical claims operations.
• Review complex cases, assess medical documentation, apply client policies, and provide recommendations.
• Maintain an individual production workload while meeting productivity, quality, accuracy, and compliance targets.
• Provide floor support, case consultations, coaching, escalation management, and knowledge-sharing sessions.
• Support training, onboarding, process documentation, knowledge repositories, and communication of process updates.
• Partner with quality, operations, training, workforce, and client stakeholders on audits, calibration, compliance, and process improvement.

Requirements

• Active and unrestricted US Registered Nurse (USRN) license.
• Bachelor’s Degree in Nursing (BSN).
• 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.
• Knowledge of medical terminology, disease processes, treatment protocols, clinical documentation review, disability management, and insurance claims processes.
• Strong analytical, critical-thinking, time-management, multitasking, prioritization, and stakeholder-management skills.
• Excellent written and verbal English communication skills; proficiency with Microsoft Office applications, particularly Excel, Word, PowerPoint, and Outlook. Willingness to work a shifting schedule is required.

Nice to have

• Experience supporting disability claims, group benefits, or similar insurance accounts.
• Lean Six Sigma or continuous improvement exposure.
• Experience facilitating training and coaching sessions.
• Background in quality auditing, process calibration, leadership, or project management.

Culture & Benefits

• Full-time role combining clinical claims production responsibilities with subject matter expertise.
• Work in a fast-paced clinical operations and business process environment.
• Opportunity to contribute to quality, compliance, operational efficiency, and continuous improvement initiatives.