Subject Matter Expert – Learning & Development (Claims Adjudication)

About the role

This hybrid position focuses on designing, delivering, and maintaining training solutions for claims adjudication and health‑care compliance within provider and payer environments. The role operates during night‑shift hours to provide global coverage and ensure consistent knowledge transfer across multiple functional teams.

Key responsibilities

• Design comprehensive training programs that build capability in claims adjudication while aligning with business objectives and quality standards.
• Develop clear learning content that simplifies complex health‑care claim rules and workflows.
• Deliver engaging virtual and classroom sessions during night‑shift hours for hybrid teams.
• Conduct training needs analysis with operations and quality teams to identify skill gaps.
• Monitor learner performance and audit outcomes to refine materials and improve claim resolution accuracy and turnaround time.
• Ensure all content reflects current health‑care regulations, HIPAA privacy requirements, and regulatory guidance.
• Create simulations and case‑based exercises that mirror real‑world provider and payer claim scenarios.
• Provide on‑floor support during production hours, answering process queries and clarifying adjudication rules.
• Collaborate with process experts and compliance teams to keep training materials up‑to‑date.
• Track training effectiveness through surveys, assessments, and quality metrics, presenting insights to leadership.

Required profile

• Strong knowledge of health‑care claims adjudication rules, benefit structures, and payment policies.
• Experience designing technically accurate learning content for provider and payer processes.
• Ability to conduct needs analysis, deliver training, and provide post‑training support.
• Familiarity with HIPAA regulations and privacy requirements.
• Comfort working night‑shift hours and supporting a global hybrid team.

Required skills