We are seeking a Subject Matter Expert (SME) in Benefits Administration to support operations, quality, and process excellence for U.S. insurance benefits administration and health care. The SME will serve as the goto expert for complex cases, training, escalations, and workflow improvements across a voice/blended setting.

Key Responsibilities

- Escalation Handling Resolve complex customer issues received via calls, email, or workflow queues.
- Quality & Compliance — Ensure adherence to ERISA, HIPAA, ACA, COBRA, and internal audit standards.
- Process Support — Identify gaps, recommend improvements, and support SOP updates.
- Training & Coaching — Conduct refreshers, calibrations, and knowledge sessions for new and existing team members.
- Operational Support — Assist TL/AM with performance insights, RCA, and workflow management.
- Open Enrollment Support — Provide expert guidance during OE, including testing, communication, and issue resolution.

Required Qualifications





- 5–8 years of experience in U.S. benefits administration or healthcare insurance operations.
- Should have Insurance Healthcare or Benefit administration experience with voice calling US geo.
- Strong understanding of eligibility, enrollments, documentation of medical records, QLEs, life/disability intake, and plan rules.
- Experience in voice or blended processes.
- Ability to interpret SPDs, plan documents, and carrier guidelines.
- Excellent communication skills for customer and internal interactions.
- Strong analytical and problemsolving ability.

Preferred Qualifications

- Experience supporting open enrollment, transitions, or new client onboarding.
- Familiarity with platforms like Workday, ADP, Benefitfocus, Alight, Mercer, etc.
- Certifications such as CEBS, GBA, RPA, SHRMCP, PHR (added advantage).

📌 SME - Benefits Administration (US Insurance) (Kerala)
🏢 Sutherland
📍 Kerala