USRN Subject Matter Expert (SME) - Clinical Claims Operations
Core
Licensed US Registered Nurse providing clinical expertise, case review, and operational coaching for disability and clinical claims operations.
Role type
Senior IC clinical claims subject matter expert (dual production and support)
Builds
Disability claims decisions and clinical documentation reviews for insurance clients
Domain
US Healthcare Insurance / Disability Claims
Required skills
US Registered Nurse (USRN) license, clinical claims review, disability management, medical documentation review, utilization management, case management, workers' compensation, medical review, insurance claims operations, medical terminology, disease processes, treatment protocols
Preferred skills
Healthcare BPO/shared services environment experience, Lean Six Sigma, continuous improvement, training facilitation, quality auditing, process calibration, leadership, project management
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 teams on compliance and audits
Seniority
Senior, hands-on IC with production responsibilities