Training Specialist | Clinical Claims
Sign up free to see how well your resume matches this role.
What you'll do
- Facilitate new hire, cross-training, upskilling, and refresher training programs.
- Deliver instructor-led, virtual, and blended learning sessions for clinical claims associates and healthcare professionals.
- Ensure accurate transfer of client, clinical, operational, and compliance-related knowledge.
- Conduct calibration sessions and knowledge reinforcement activities.
- Develop, update, and maintain training materials, lesson plans, facilitator guides, assessments, and job aids.
- Translate complex clinical and claims-related information into learner-friendly content.
- Incorporate adult learning principles and best practices into training design.
- Monitor trainee progress and training effectiveness through assessments and observations.
- Identify learning gaps and provide targeted coaching interventions.
- Collaborate with Operations and Quality teams to address performance challenges through training solutions.
- Ensure all training content aligns with client requirements, healthcare regulations, operational policies, and compliance standards.
- Maintain training documentation and completion records.
What they're looking for
- Active Philippine Registered Nurse (USRN) with an unrestricted US RN License (NCLEX passer).
- Bachelor's Degree in Nursing.
- Minimum 2 years recent clinical experience in a hospital, utilization review, case management, disability management, claims, or healthcare operations environment.
- Minimum 1 year experience in training, coaching, facilitation, mentoring, preceptorship, or learning and development role.
- Strong knowledge of clinical documentation, medical terminology, healthcare delivery systems, and disability/claims processes.
- Excellent verbal and written English communication skills.
- Strong presentation, facilitation, and classroom management skills.
- Proficiency in Microsoft Office applications (Excel, PowerPoint, Word, Outlook).
- Ability to analyze performance data and recommend learning interventions.
- Willingness to work in a shifting schedule and support business requirements.
Nice to have
- Training certification (Train-the-Trainer, Learning & Development, Instructional Design, or equivalent).
- Experience supporting: Disability Claims, Group Benefits, Clinical Claims Review, Case Management, Utilization Management, Insurance or Healthcare BPO operations
- Experience in curriculum design, e-learning development, and learning management systems (LMS).
- Prior experience supporting similar insurance/benefits accounts.
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
Company Description
About Sutherland
Artificial Intelligence. Automation. Cloud engineering. Advanced analytics. For business leaders, these are key factors of success. For us, they’re our core expertise.
We work with iconic brands worldwide. We bring them a unique value proposition through market-leading technology and business process excellence.
We’ve created over 200 unique inventions under several patents across AI and other critical technologies. Leveraging our advanced products and platforms, we drive digital transformation, optimize critical business operations, reinvent experiences, and pioneer new solutions, all provided through a seamless “as a service” model.
For each company, we provide new keys for their businesses, the people they work with, and the customers they serve. We tailor proven and rapid formulas, to fit their unique DNA. We bring together human expertise and artificial intelligence to develop digital chemistry. This unlocks new possibilities, transformative outcomes and enduring relationships.
Sutherland
Unlocking digital performance. Delivering measurable results.
Job Description
The Trainer is responsible for designing, facilitating, and evaluating training programs for employees supporting an AO Clinical Claim Program. This role ensures that clinical and operational teams possess the knowledge, skills, and competencies required to accurately assess, process, and support disability and clinical claims while maintaining compliance with client requirements, healthcare standards, and operational goals.
The Trainer partners closely with Operations, Quality, Clinical Leadership, and Client stakeholders to drive performance, improve knowledge retention, and support business objectives through effective learning interventions.
Key Responsibilities
Training Delivery & Facilitation
- Facilitate new hire, cross-training, upskilling, and refresher training programs.
- Deliver instructor-led, virtual, and blended learning sessions for clinical claims associates and healthcare professionals.
- Ensure accurate transfer of client, clinical, operational, and compliance-related knowledge.
- Conduct calibration sessions and knowledge reinforcement activities.
Curriculum Development
- Develop, update, and maintain training materials, lesson plans, facilitator guides, assessments, and job aids.
- Translate complex clinical and claims-related information into learner-friendly content.
- Incorporate adult learning principles and best practices into training design.
Performance Support
- Monitor trainee progress and training effectiveness through assessments and observations.
- Identify learning gaps and provide targeted coaching interventions.
- Collaborate with Operations and Quality teams to address performance challenges through training solutions.
Quality & Compliance
- Ensure all training content aligns with client requirements, healthcare regulations, operational policies, and compliance standards.
- Maintain training documentation and completion records.
- Support audit readiness by ensuring consistency and accuracy of training materials.
Stakeholder Partnership
- Partner with Operations Managers, Clinical Leaders, Quality Analysts, and Workforce teams to identify training needs.
- Support implementation of process changes, workflow updates, and client-driven initiatives.
- Provide recommendations for continuous improvement in training programs and learner performance.
Reporting & Analytics
- Track and report training metrics, certification results, learning effectiveness, and post-training performance outcomes.
- Analyze trends and recommend action plans to improve learning retention and operational results.
Qualifications
Minimum Qualifications
Required
- Active Philippine Registered Nurse (USRN) with an unrestricted US RN License (NCLEX passer).
- Bachelor's Degree in Nursing.
- Minimum 2 years recent clinical experience in a hospital, utilization review, case management, disability management, claims, or healthcare operations environment.
- Minimum 1 year experience in training, coaching, facilitation, mentoring, preceptorship, or learning and development role.
- Strong knowledge of clinical documentation, medical terminology, healthcare delivery systems, and disability/claims processes.
- Excellent verbal and written English communication skills.
- Strong presentation, facilitation, and classroom management skills.
- Proficiency in Microsoft Office applications (Excel, PowerPoint, Word, Outlook).
- Ability to analyze performance data and recommend learning interventions.
- Willingness to work in a shifting schedule and support business requirements.
Preferred
- Training certification (Train-the-Trainer, Learning & Development, Instructional Design, or equivalent).
- Experience supporting:
- Disability Claims
- Group Benefits
- Clinical Claims Review
- Case Management
- Utilization Management
- Insurance or Healthcare BPO operations
- Experience in curriculum design, e-learning development, and learning management systems (LMS).
- Prior experience supporting similar insurance/benefits accounts.
Additional Information
Internal Qualifications:
- Must have Annual PDP score of Exceeds Expectations (4) or Outstanding (5)
- Tenure of at least 12 months on the current role
- No Active DA
Company
Company facts come from this company's own listings. We only show what the postings themselves carry.