Claims SME
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Experience Required:
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Job Summary
Claims SME Property & Casualty (P&C) Insurance
Who are we
Fulcrum Digital is an agile and next-generation digital accelerating company providing digital transformation and technology services right from ideation to implementation. These services have applicability across a variety of industries including banking & financial services insurance retail higher education food healthcare and manufacturing.
Experience Required
- 5 to 8 years of end-to-end Property & Casualty (P&C) claims handling experience.
- Strong expertise in claims adjudication coverage analysis liability determination and claims lifecycle management.
- Experience supporting process transitions quality initiatives and operational excellence programs.
Key Responsibilities
- Act as the Subject Matter Expert (SME) for P&C claims processes policy coverage and claims adjudication.
- Provide guidance and support to claims teams on complex claims coverage interpretation and liability assessments.
- Review high-value or complex claims to ensure accurate and compliant claim decisions.
- Support quality assurance activities through claim file reviews audits and feedback sessions.
- Assist in developing and maintaining Standard Operating Procedures (SOPs) process documentation and training materials.
- Conduct knowledge-sharing sessions and mentor team members on claims best practices and industry standards.
- Identify process improvement opportunities and support implementation of operational efficiencies.
- Assist with new client transitions workflow stabilization and knowledge transfer activities.
- Collaborate with stakeholders to resolve escalations and ensure timely claim resolution.
- Monitor claims trends identify risks and recommend corrective actions to improve claim outcomes.
- Support reporting requirements root cause analysis and continuous improvement initiatives.
Skills Required
- Deep understanding of Property & Casualty (P&C) insurance claims policy coverage and claims handling practices.
- Strong analytical and problem-solving skills with the ability to evaluate complex claim scenarios.
- Excellent communication and stakeholder management abilities.
- Strong knowledge of claims quality standards compliance requirements and operational best practices.
- Experience conducting audits quality reviews and process assessments.
- Ability to support training coaching and knowledge management initiatives.
- Strong decision-making and escalation management skills.
- Proficiency in Microsoft Excel PowerPoint and operational reporting tools.
- Ability to manage multiple priorities in a fast-paced environment.
Required Skills:
P&C claims process and Underwriting with lead experience
