Who are we

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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.

Job Title: Sr. Claims Analyst / Subject Matter Expert (SME)

Domain: Property & Casualty (P&C;) Insurance

Reports To: Claims Team Lead / Operations Manager ─────────────────────────────────────────────

ROLE OVERVIEW ─────────────────────────────────────────────

The Sr. Claims Analyst / SME is a seasoned claims skilled 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.

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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.





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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, coverage interpretation, and best practices.
- Support onboarding, training, and upskilling of new and junior claims analysts.
- Provide structured feedback and coaching to improve team performance and claims quality.
- Contribute to knowledge base creation, training materials, and process documentation.
- Represent the claims function in process transitions, client discussions, and internal working groups.

Collaboration & Stakeholder Coordination

- Coordinate with customers, adjusters, brokers, carriers, and internal teams to facilitate smooth claim resolution.
- Partner with the Team Lead on capacity planning, work allocation, and workload management.




- Communicate claim status updates, escalations, and quality findings to relevant stakeholders.
- Support continuous improvement and transformation initiatives across the claims function.

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SKILLS REQUIRED ─────────────────────────────────────────────

Technical Skills

- Deep knowledge of P&C; insurance claims processes, coverage types, policy interpretation, and regulatory requirements.
- Strong analytical and investigative capabilities with attention to detail.
- Proficiency in claims management systems, MS Office (Excel, Word, PowerPoint), and reporting tools.
- Sound understanding of quality frameworks, compliance standards, and audit methodologies.

Soft Skills

- Excellent written and verbal communication skills with the ability to explain complex claims concepts clearly.
- Strong problem-solving skills and sound judgement in ambiguous or high-stakes situations.
- Coaching and mentoring ability with a collaborative team-first mindset.
- Ability to manage multiple priorities, meet deadlines, and maintain accuracy under pressure.
- Self-driven and capable of working independently as well as within cross-functional teams.

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KEY PERFORMANCE INDICATORS (KPIs)

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- Claims processing accuracy and quality audit scores.
- SLA adherence and turnaround time on assigned claims.
- Reduction in errors, rework, and escalations within the team.
- Effectiveness of coaching, training, and knowledge transfer activities.
- Timely delivery of quality reports, scorecards, and process documentation.

📌 Claims SME (Pune)
🏢 Fulcrum Digital
📍 Pune