SME-Ins Claims

Job Summary

Responsibilities

• Analyze incoming insurance claims and related customer service requests to validate coverage identify documentation gaps and ensure that each case is processed accurately in line with internal guidelines and domain standards.
• Handle customer service interactions across multiple channels to provide clear explanations on claims status required next steps and resolution timelines while maintaining a calm and empathetic communication style.
• Coordinate with internal operations teams to streamline claim intake and assessment workflows and contribute to improved turnaround time and reduced rework through detailed case reviews.
• Perform end to end documentation checks on claims files to confirm that information is complete consistent and compliant with process rules thereby reducing downstream processing issues.
• Investigate claim details using available systems and tools to highlight potential inconsistencies and escalate complex or ambiguous cases according to defined escalation paths.
• Provide structured feedback on recurring customer service issues and claim processing pain points helping product and process owners refine procedures and service scripts.
• Support continuous improvement initiatives by tracking key performance metrics related to claim resolution accuracy customer satisfaction scores and cycle time and by suggesting practical enhancements.
• Collaborate with training and quality teams by sharing real world case scenarios and insights from daily work to shape more effective learning materials and quality checklists.
• Contribute to knowledge base updates by drafting clear process notes and frequently asked questions that help colleagues resolve claims and customer queries more efficiently.
• Adapt to a rotational shift environment by managing workload intelligently and maintaining a consistent level of responsiveness and quality regardless of shift timing.
• Utilize hybrid work arrangements effectively by maintaining secure and confidential handling of sensitive claim information both on site and remotely in accordance with company policies.
• Support the company purpose by helping customers navigate stressful claim situations with clarity and fairness thereby strengthening trust in the organization and its insurance service offerings.
• Participate in cross functional discussions to represent claims and customer service perspectives ensuring that operational changes positively impact end customers and broader society through reliable risk protection.

Qualifications

• Demonstrate solid experience in insurance claims domain activities with two to four years of hands on involvement in processing or supporting claims operations in a professional setting.
• Show strong customer service skills including active listening precise communication and issue resolution capabilities that drive high satisfaction and minimize repeated contacts.
• Apply foundational knowledge of property and casualty insurance concepts such as policy coverage limits deductibles exclusions and claim life cycle to interpret case details effectively.
• Exhibit proficiency in working with standard office productivity tools and claims related applications to log cases update records and generate simple reports for stakeholders.
• Display adaptability in hybrid work and rotational shifts by organizing tasks efficiently managing time constraints and maintaining consistent performance levels.
• Demonstrate analytical thinking and attention to detail when reviewing claim facts and customer information which supports accurate decisions and fair outcomes for all parties.
• Show openness to learn new processes regulatory updates and system enhancements in the insurance domain and translate that learning into better daily execution.

Certifications Required