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
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5 to 8 years of end-to-end Property & Casualty (P&C) claims handling experience.
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Strong expertise in claims adjudication, coverage analysis, liability determination, and claims lifecycle management.
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Experience supporting process transitions, quality initiatives, and operational excellence programs.
Key Responsibilities
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Act as the Subject Matter Expert (SME) for P&C claims processes, policy coverage, and claims adjudication.
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Provide guidance and support to claims teams on complex claims, coverage interpretation, and liability assessments.
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Review high-value or complex claims to ensure accurate and compliant claim decisions.
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Support quality assurance activities through claim file reviews, audits, and feedback sessions.
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Assist in developing and maintaining Standard Operating Procedures (SOPs), process documentation, and training materials.
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Conduct knowledge-sharing sessions and mentor team members on claims best practices and industry standards.
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Identify process improvement opportunities and support implementation of operational efficiencies.
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Assist with new client transitions, workflow stabilization, and knowledge transfer activities.
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Collaborate with stakeholders to resolve escalations and ensure timely claim resolution.
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Monitor claims trends, identify risks, and recommend corrective actions to improve claim outcomes.
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Support reporting requirements, root cause analysis, and continuous improvement initiatives.
Skills Required
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Deep understanding of Property & Casualty (P&C) insurance claims, policy coverage, and claims handling practices.
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Strong analytical and problem-solving skills with the ability to evaluate complex claim scenarios.
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Excellent communication and stakeholder management abilities.
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Strong knowledge of claims quality standards, compliance requirements, and operational best practices.
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Experience conducting audits, quality reviews, and process assessments.
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Ability to support training, coaching, and knowledge management initiatives.
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Strong decision-making and escalation management skills.
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Proficiency in Microsoft Excel, PowerPoint, and operational reporting tools.
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Ability to manage multiple priorities in a fast-paced environment.