Training Specialist | Clinical Claims (Pooling)

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.
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.

Employment type
Full-time

Work arrangement
No