01Overview
ROLE OVERVIEW
The Sr. Claims Analyst / SME is a seasoned claims qualified who combines deep end-to-end claims expertise with a quality and governance mindset. Acting as the go-to domain authority within the team, this role bridges frontline claims handling and quality assurance supporting accuracy, compliance, and continuous improvement across the claims lifecycle. The SME also serves as a key escalation point, mentor, and process champion for junior analysts.
EXPERIENCE REQUIRED
- 7+ years of end-to-end claims handling experience in P&C; Insurance.
- Proven experience in claims quality reviews, audits, or compliance validation.
- Prior experience in a mentoring, coaching, or informal leadership capacity preferred.
- Exposure to transitions, SOP development, or process improvement initiatives is an advantage.
KEY RESPONSIBILITIES
Claims Handling & Oversight
- Manage complex and high-value P&C; claims from FNOL (First Notice of Loss) through to final settlement.
- Review claim documents, verify policy coverage, limits, deductibles, and liability decisions.
- Conduct thorough claims investigations and provide recommendations on coverage and settlement.
- Act as an escalation point for complex, disputed, or high-risk claims.
- Ensure all claims are processed accurately, within agreed SLAs and compliance requirements.
Quality, Compliance & Governance
- Conduct periodic quality audits and file reviews to ensure accuracy, consistency, and regulatory compliance.
- Evaluate coverage decisions, claim investigations, and settlement outcomes for quality benchmarks.
- Identify process gaps, errors, and improvement opportunities; recommend and implement corrective actions.
- Prepare quality scorecards, audit reports, and performance dashboards for Team Leads and management.
- Assist in maintaining and updating SOPs, quality guidelines, and claims handling frameworks.
SME & Knowledge Management
- Serve as the primary domain expert and go-to resource for claims queries, cov .
