Subject Matter Expert - Insurance Claims

Company Description

You are joining Sutherland Global Services, a global business transformation company offering an integrated set of back-office and customer service support services.

One of the largest, independent process transformation companies in the world, Sutherland serves marquee clients in major industry verticals. With our head office in Rochester, New York, USA, Sutherland spans 60 location across 19 countries supporting 8 industries, focusing on delivering results that businesses can see, resulting in improved experiences that their customers can feel.

As a SME, you will be the designated technical expert for a team of 20-23 consultants who will carry out below tasks (but are not limited to):

• Patient Care: Coordinating case from multiple providers and helping injured patients who may not be able to manage their care on their own
• Manage administrative responsibilities: Helping patients with tasks like scheduling transportation, intake, paying medical bills, arranging translation services (care coordinator activities)
• Transportation & Language (T&L) - Voice & Back office and work on scheduling viz. transportation of injured worker, physiotherapy, wheelchair, talking to third party etc.

Job Description

KEY RESPONSIBILITIES OF THE SME

• Empower the Work: Create, facilitate, Huddle Sessions to equip staff with fundamental skills and knowledge.
• Conduct BQM / Remedial training for the folks in nesting. Also conduct floor interventions for BQ teams.
• Strengthen relationships: Establish and maintain communication with clients and/or team members; understand needs, resolve issues, and meet expectations
• Take the lead: Delivering new hire training for the business, ensure to give a good learning experience for the new hires, ensuring to equip new hires with relevant skill set to meet the production goals from the first month post nesting Should partner with quality and training manager to identify skill and knowledge gap that leads to an instable performance trend Work with the training manager to prepare training content to run a BQ intervention for the business and Work with the training manager in catering the learning via the update management process and new launches.
• Support the team with complex queries and fill out accurate reports.
• Support the team manager and ensure the team delivers against key service levels metrics but also creates value for the clients by impacting business outcomes
• Handle phone calls and transactions for the program.
• Supervise and coach learners in nesting & BQM type environments;
• Coach and give feedback to trainees to help them fulfill performance metrics.

Qualifications

MINIMUM QUALIFICATIONS:

• Minimum 24 months of healthcare/workers comp experience managing customer-facing accounts preferably managing processes such as intake, scheduling, credentialing, medical bill reviews.
• Excellent Data Mining skills
• Ability to think outside of traditional role to evaluate business implications
• Ability to interpret data, identify trends, and make suggestions for improvements
• Strong verbal and written communication skills; be able to communicate in a clear, constructive, and professional manner
• Demonstrated leadership skills; be able to take the lead in making improvements and resolving issues
• Blended operations which involve back-office work, making outbound and receiving inbound calls
• PHRN or USRN license is required