Subject Matter Expert-Claims

Position: SME – SMART Claims 

Location: Noida

Shift: 6pm-3am IST-Hybrid 3 days

Reporting: SM/AVP – SMART Claims/ Operations Unit - India

Role: The Claims Assistant plays a key role in supporting the Claims Department at Edge Claims by assisting adjusters, managing documentation, coordinating communication, and ensuring timely progression of claims files. This role is essential for maintaining workflow efficiency, compliance, and high-quality customer service 

Key Responsibilities 

• P&C Claims Domain Expertise 
• Strong ability to set up and validate FNOL (First Notice of Loss) and subsequent documentation to determine liability and coverage.  
• Ability to identify complex, high-exposure, or litigated claims and communicate with adjusters on appropriate handling strategies. 
• Ability to interpret P&C policy wordings (auto, home, commercial) and apply coverage terms, conditions, and exclusions to real-world loss scenarios 
• Documentation Management 
• Gather, upload, and organize all claim-related documents including loss notices, police reports, photos, invoices, estimates, and statements. 
• Maintain file accuracy and ensure compliance with audit standards. 
• Act as a liaison between adjusters, insured parties, brokers, vendors, and internal teams. 
• Claims Processing Support 
• Ability to interpret P&C policy wordings (auto, home, commercial) and apply coverage terms, conditions, and exclusions to real-world loss scenarios. 
• Assist adjusters with obtaining reports, estimates, salvage details, subrogation documents, or medical records. 
• Track outstanding requirements and send reminders to ensure timely file progression. 
• Prepare standard letters, notices, and email correspondence. 
• Payment & Reserve Support 
• Assist with processing payment requests, collecting supporting documents, and verifying proper approvals. 
• Update reserves in the system as directed by adjusters or management. 
• Subrogation & Recovery Support 
• Ability to recognize subrogation, salvage, and recovery opportunities and work on optimal next steps.  
• Collect and organize documents required for subrogation referrals. 
• Coordinate with the Total Loss and Material Damage Team for efficient handling of Property Damage and Physical Damage Losses. 
• Track recovery status and update files accordingly. 
• Reporting & Compliance 
• Ability to work with intelligent claims platforms (rules engines, AI/ML, OCR, decisioning tools, straight-through processing engines) and translate business needs into system requirements. 
• Ability to define and maintain business rules for auto-adjudication, triage, and routing in collaboration with technology teams. 
• Ability to validate and test new automations (e.g., claim segmentation, fraud flags, severity scoring) and sign off on functional accuracy. 
• Ability to interpret analytics dashboards and MI reports (cycle time, leakage, LAE, indemnity trends) and convert insights into actionable recommendations for adjusters. 
• Prepare weekly/monthly claims status reports. 

Education & Experience 

• Bachelor's or masters degree preferred (Business, Insurance, or related field); or relevant work experience. 

• Prior experience in claims, insurance, or administrative support is a plus. 

Skills & Competencies 

• Strong organizational and time-management skills. 

• Excellent written and verbal communication abilities. 

• Attention to detail and accuracy in handling documentation. 

• Ability to work in a fast-paced environment and manage multiple files. 

• Proficiency in MS Office and claims management software. 

• Customer-service orientation and a collaborative mindset. 

please share your resume at shobhana@futuristicuwltd.com