Subject Matter Expert USRN

Job Summary

The SME serves as the clinical and operational expert for the Clinical Claims Program providing guidance on claims processes medical documentation review disability management quality standards and client-specific procedures. This is a dual-role position requiring the incumbent to manage an individual clinical claims workload while simultaneously supporting the team through coaching case consultations floor support training and process improvement initiatives.

The role is ideal for a licensed US Registered Nurse (USRN) with strong clinical claims experience excellent analytical skills and the ability to collaborate effectively with operations quality training and client stakeholders.

Key Responsibilities

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

Qualifications :

Required Qualifications

• Active and unrestricted US Registered Nurse (USRN) license.
• Bachelors Degree in Nursing (BSN).
• Minimum 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.
• Excellent analytical communication coaching and stakeholder management skills.
• Proficiency in Microsoft Office applications.
• Ability to balance production responsibilities with SME support functions in a fast-paced environment.
• Willingness to work flexible or shifting schedules.

Preferred Qualifications

• Experience supporting 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.

Note: This is not a dedicated support role. Successful candidates will be expected to maintain an individual production workload while providing SME support coaching escalation management and operational guidance to the team.

Additional Information :

Internal Qualifications:

• 12 months tenure in the recent role
• No Active DA for the past 6 months
• Recent annual PDP rating of 4 (Exceeds Expectations) or 5 (Outstanding)

Remote Work :

No

Employment Type :

Full-time