Subject Matter Expert - USRN
Core
Clinical and operational expert for the Clinical Claims Program, managing individual claims workload while providing coaching, case consultations, and process improvement support.
Role type
Senior IC clinical claims subject matter expert (nursing)
Builds
Clinical claims decisions, documentation reviews, and operational guidance for disability and insurance claims
Domain
US healthcare insurance claims and disability management
Required skills
US Registered Nurse (USRN) license, clinical claims review, disability management, medical documentation review, utilization management, case management, workers' compensation, insurance claims operations, analytical skills, coaching, stakeholder management
Preferred skills
Group benefits support, training and quality auditing, process calibration, Lean Six Sigma, continuous improvement, project management
Technologies
Microsoft Office
Responsibilities
Perform end-to-end clinical claims review and assessment; serve as primary SME for complex clinical inquiries; provide floor support and real-time guidance to team members; support onboarding and knowledge management; partner with Quality and Operations to drive compliance; identify and implement process improvements
Seniority
Senior, hands-on IC with production workload
