Subject Matter Expert (SME) - Clinical Claims Operations

📋 Description

• Serve as the primary clinical subject matter expert for disability and clinical claims operations.
• Interpret and apply client-specific guidelines, medical policies, and standard operating procedures.
• Review complex cases and provide recommendations to associates and leadership teams.
• Support accurate evaluation and documentation of clinical claims based on medical evidence and
• Ensure consistency in claims handling and decision-support processes.
• Perform end-to-end clinical claims review, assessment, and documentation activities consistent with

🎯 Requirements

• Active and unrestricted US Registered Nurse (USRN) license.
• Bachelor's Degree in Nursing (BSN).
• Minimum 2-3 years of US healthcare experience in one or a combination of the following: Disability
• Extensive knowledge of medical terminology, disease processes, treatment protocols, and clinical
• Strong understanding of disability management and insurance claims processes.
• Experience working in a healthcare BPO/shared services environment preferred.