Responsible for reviewing medical information to determine if requested treatment is medically necessary and appropriate according to the given standards. Assists leads and managers when it comes to training, dealing with escalated calls, and helping transfer knowledge to other team members.

Bachelor's degree in Nursing. Must be a Philippine Registered Nurse; has an active US Registered Nurse license in any state if required by the process. At least one (1) year equivalent work experience as SME (external) or 1 year tenure in current process (internal). Excellent communication and interpersonal skills with people at all levels. Proficiency of the English language, both in verbal and written. Strong customer orientation, active listening, and excellent phone handling skills. Keen attention to details with regards to own work and of team members. Demonstrates analytical thinking and effective conflict resolution skills. Analyzes and reviews case records, evaluates client's medical status, and defines their needs and problems Utilizes experience and medical resources to interpret medical records and test results, and provide appropriate assistance to team members Reviews cases with team members to evaluate files and provide directions. Documenting processes and disseminating information to all relevant team members. Answers and document escalated calls for appropriate handling.