Subject Matter Expert (SME) - USRN - Taguig
Core
Clinical and operational resource for disability and clinical claims operations, performing end-to-end case reviews while coaching teams.
Role type
Senior IC clinical claims specialist (dual production/SME)
Builds
Disability claims decisions and medical documentation reviews
Domain
Healthcare insurance claims and disability management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
US Registered Nurse (USRN) license, clinical claims review, disability claims, utilization management, case management, medical terminology, clinical documentation review, insurance claims operations
Preferred skills
Workers' compensation, medical review, group benefits, Lean Six Sigma, training facilitation, quality auditing, leadership
Technologies
Microsoft Office (Excel, Word, PowerPoint, Outlook)
Responsibilities
Perform end-to-end clinical claims review and assessment; provide real-time floor support and coaching to associates; conduct case reviews and calibration sessions; maintain assigned production workload and meet quality metrics; facilitate training and uptraining programs; identify process improvement opportunities; partner with Quality Assurance on compliance metrics.
Seniority
Senior, hands-on IC with production targets
