Subject Matter Expert - USRN

Location: Taguig, NCR, Philippines

Company

hirify.global provides digital engineering, artificial intelligence, automation, cloud engineering, advanced analytics, and business process services for global brands.

What you will do

• Perform end-to-end clinical claims review, assessment, and documentation while meeting productivity, quality, accuracy, and compliance targets.
• Act as the primary subject matter expert for complex clinical and operational inquiries.
• Provide floor support, coaching, case reviews, escalation management, and real-time guidance to team members.
• Support onboarding, uptraining, knowledge management, and training initiatives.
• Partner with Quality, Operations, Training, and client stakeholders to improve compliance, consistency, and service excellence.
• Identify process improvement opportunities and support the implementation of best practices.

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.
• Strong knowledge of medical terminology, clinical documentation review, disability management, and insurance claims processes.
• Strong analytical, communication, coaching, and stakeholder management skills, with proficiency in Microsoft Office.
• Ability to balance an individual production workload with SME support functions and willingness to work flexible or shifting schedules.

Nice to have

• Experience with Disability Claims, Group Benefits, or related insurance programs.
• Background in training, quality auditing, and process calibration.
• Lean Six Sigma, continuous improvement, leadership, or project management experience.

Culture & Benefits

• Full-time employment in a fast-paced clinical claims operations environment.
• Opportunity to combine individual clinical claims production with coaching and operational guidance.
• Collaboration with Quality, Operations, Training, and client teams.

Hiring process

• Internal candidates must have 12 months of tenure in their recent role.
• Internal candidates must have no active DA during the past 6 months.
• Internal candidates must have a recent annual PDP rating of 4 or 5.