Subject Matter Expert – Learning & Development (Claims Adjudication)

About the role

This hybrid, night‑shift position serves as a Subject Matter Expert in Learning & Development, designing and delivering training solutions for claims adjudication and health‑care compliance across provider and payer environments. The role supports global coverage while ensuring accurate, regulatory‑aligned claim handling and continuous capability building for multiple functional teams.

Key responsibilities

• Design comprehensive training programs that strengthen capability in claims adjudication for both provider and payer operations.
• Develop clear learning content that simplifies complex health‑care claim rules, workflows, and regulatory requirements.
• Deliver engaging virtual and classroom sessions during night‑shift hours to support hybrid teams.
• Conduct training needs analysis with operations and quality teams to identify skill gaps and prioritize interventions.
• Monitor learner performance and quality audit data to refine materials and improve claim resolution accuracy and turnaround time.
• Ensure all content reflects current HIPAA and health‑care regulatory requirements.
• Create simulations and case‑based exercises that mirror real‑world claim scenarios.
• Provide on‑floor support during production hours, answering process queries and clarifying adjudication rules.
• Collaborate with process experts and compliance teams to update training whenever benefit designs, coding standards, or regulations change.
• Track training effectiveness through surveys, assessments, and quality metrics, presenting insights to business leaders.
• Maintain detailed training records for internal audits and regulatory compliance.
• Coordinate with workforce management to schedule sessions that minimize business disruption.
• Support adoption of digital learning tools and knowledge repositories for on‑demand access to updated guidance.

Required profile

• Strong knowledge of health‑care claims adjudication rules, benefit structures, and payment policies.
• Experience designing and delivering training for provider and payer environments.
• Ability to translate complex regulatory information into clear, actionable learning content.
• Excellent communication skills for virtual and classroom delivery during night‑shift hours.
• Analytical mindset to assess training impact using performance and quality data.

Required skills