Description
We are seeking a proactive and detail-oriented Domain Expert to oversee multiple teams responsible for processing Life & Health and US Insurance claims. The successful candidate will provide expert guidance on Life & Health products, interpret and apply US regulatory frameworks, and define business requirements for system enhancements.
Key Responsibilities
- Provide expert guidance on Life & Health products including Term/Whole/UL Life, Group Health, Medicare/Medicaid, ACA plans, Disability, Critical Illness, and Supplemental Health.
- Interpret and apply US regulatory frameworks such as NAIC, HIPAA, ACA, ERISA, and state-specific rules to improve end-to-end processes.
- Define and validate business requirements for system enhancements, automation, and digital transformation.
- Collaborate with actuarial, compliance, operations, IT, and product teams to ensure alignment.
- Analyse operational and claims data to identify trends, risks, and improvement opportunities.
- Review policy forms, customer communications, and process documentation for accuracy and compliance.
- Provide training, domain knowledge sessions, and SME support for cross-functional teams.
Skills, Knowledge & Expertise
- 5–10+ years of experience in US Life & Health insurance.
- Strong understanding of underwriting, claims, product structures, and regulatory compliance.
- Experience with policy administration, underwriting, or claims systems.
- Ability to translate business needs into clear functional requirements.
- Strong analytical, documentation, and communication skills.
- Bachelor or Masters degree preferred.
- GB and Lean certified.
- Insurance certification.
- Deep domain expertise and regulatory awareness.
- Process optimisation and problem-solving ability.
- Cross-functional collaboration and stakeholder management.
- High attention to detail and strong business acumen.