Senior Subject Matter Expert - Insurance Claims/Platform Implementation - InsuranceTech

Role : Senior Subject Matter Expert Insurance - Claims Platform Implementation (Provider Management, FWA & Claims) - InsuranceTech

Location : Mumbai / Pune ( with International Project Travelling)

Job Summary:

Role Summary:

Looking for a Senior Subject Matter Expert (SME) to lead the requirement discovery, analysis, and customer-facing workshops for our next-generation insurance platform rollouts in Singapore and Indonesia. This role demands a deep understanding of the end-to-end platform implementation of Provider Management, Claims Adjudication, and Fraud, Waste & Abuse (FWA) modules.

Key Responsibilities :

- Lead end-to-end requirement workshops with client business and IT stakeholders.

- Own and drive the platform implementation roadmap across Provider Management, FWA, and Claims.

- Translate domain needs into functional platform capabilities with clear use case articulation.

- Act as the single point of contact for clients on requirement validation, change requests, and clarifications.

- Collaborate with Product Owners, Architects, and Engineering to ensure alignment of customer needs with platform features.

- Identify gaps and drive platform enhancements to enable scalability across markets.

- Conduct competitive analysis and benchmark client expectations against industry standards.

Educational Qualification & Work Experience :

- PG / MBA / BE / B.Tech with min 12+ years of experience in Health / Life Insurance domain, with minimum 5+ years in platform implementation roles.

- Deep knowledge of Provider Lifecycle Management, Contracting & Tariffs, Claims Intake to Settlement, and FWA Detection Approaches.

- Proven experience leading discovery and design workshops in APAC markets.

- Experience in dealing with policy administration systems, integration platforms, and rules-based engines.

- Strong communication and stakeholder management skills, especially with cross-functional and regional teams.

- Ability to work in high-paced, multi-country programs with shifting priorities.