Training Specialist | Clinical Claims

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).
• Bachelors 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 

Remote Work :

No

Employment Type :

Full-time