7 дней назад
USRN Subject Matter Expert (SME) - Clinical Claims Operations
Вакансия из Hirify Global, списка международных tech-компанийДля мэтча и отклика нужен Plus
Мэтч & Сопровод
Для мэтча с этой вакансией нужен Plus
Описание вакансии
Текст:
TL;DR
USRN Subject Matter Expert (SME) - Clinical Claims Operations (Clinical Claims): Reviewing and documenting clinical claims while providing subject-matter expertise, coaching, escalation support, and process guidance for disability and insurance operations with an accent on medical evidence, clinical documentation, and compliance. Focus on balancing an assigned production workload with case consultations, quality improvement, training, and stakeholder collaboration.
Location: Taguig, Philippines
Company
provides AI, automation, cloud engineering, advanced analytics, and business process services for global brands.
What you will do
- Review, assess, and document clinical and disability claims using medical evidence, client policies, and established protocols.
- Maintain an assigned production workload while meeting productivity, quality, accuracy, and compliance targets.
- Provide floor support, case consultations, escalation handling, coaching, and knowledge-sharing to agents and analysts.
- Facilitate refresher training, support onboarding, and maintain process documentation and knowledge repositories.
- Partner with Quality Assurance, Operations, Training, Workforce, and client stakeholders on calibration, audits, corrective actions, and process improvements.
- Analyze trends, defects, and operational challenges and recommend workflow and claims-review enhancements.
Requirements
- Active and unrestricted US Registered Nurse (USRN) license and a Bachelor's Degree in Nursing.
- 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, communication, time-management, prioritization, multitasking, and stakeholder-management skills.
- Proficiency in Microsoft Office, particularly Excel, Word, PowerPoint, and Outlook.
- Willingness to work a shifting schedule and support business requirements. Ability to balance personal production responsibilities with SME support functions.
Nice to have
- Experience with disability claims, group benefits, or similar insurance accounts.
- Lean Six Sigma or continuous improvement exposure.
- Experience facilitating training and coaching sessions.
- Quality auditing, process calibration, leadership, or project management experience.
Culture & Benefits
- Work in a technology-enabled business process environment focused on AI, automation, analytics, and operational excellence.
- Collaborate with Operations, Quality, Training, Workforce, and client teams.
- Support continuous improvement, knowledge sharing, and compliance-focused clinical operations.
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