Claims SME

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.