Subject Matter Expert - USRN
Job Description
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.
Requirements
Function: Customer Service
Experience Level: Not Applicable