Summary role description:

Hiring for an SME (Subject Matter Expert) – Claims for an InsurTech platform provider, Life and Health Insurances

Company description:

Our client is a VC-funded InsurTech platform company, providing software platforms for Life Insurance and Health Insurance companies across the globe. Leveraging their domain expertise, regulatory knowledge and technology experience, they architect innovative products and disrupt the Insurance value chain from Customer Acquisition to Engagement. Their products serve customers across the APAC region. 

Role details:

• Title / Designation: SME (Subject Matter Expertise) – Claims
• Reporting Manager:  Chief Product Officer/ Head of Business Solutions Group
• Location: Singapore, Indonesia
• Work Mode: Remote

Role & responsibilities:

• Participate in workshops with claims heads, adjudicators, and operations teams.
• Define and document health claims flows — from pre-authorization to payment.
• Assist in the configuration of rules for eligibility, benefit payouts, and fraud scenarios.
• Validate ICD/PCS code mapping, duplicate check logic, and claim audit workflows.
• Provide input for STP configurations and workbench design.

Candidate requirements:

• Minimum 6+ years of experience in life/health claims operations or consulting roles.
• Sound knowledge of claims processing workflows and adjudication logic.
• Familiarity with fraud patterns, medical codes, and clinical documentation.
• Understanding of platform configuration and integration with policy systems.
• Good communication skills to work with both business and technical stakeholders.

Selection process:

• Interview by Chief Product Officer/ Head of Business Solutions Group
• Interview by Chief Technology Officer
• HR discussions