Wipro is Hiring | Subject Matter Expert- US Life, Pension and Annuity
Job Description
Subject Matter Expert (SME) Life & Annuity Claims (US Benefits)
Summary
The SME is the process and claims-knowledge anchor for the Life, AD&D and Annuity claims team. The role resolves complex claims, guides processors, owns SOPs, training and quality, and partners with the client across shores to meet SLA, TAT and quality targets. The SME also identifies opportunities to streamline, standardize and automate the process.
Roles & Responsibilities
1. Expertise claims & Complex Case Handling
- Maintain strong understanding of client plan provisions, product rules, processing guidelines and SLA metrics
- Manually process complex Life, AD&D and Annuity claims that need plan knowledge, analysis and interpretation, including benefit calculations
- Research complex or exception cases; analyse fact patterns, apply plan provisions and recommend resolutions
- Act as the first point of escalation for processor queries and clarify guidelines in real time
2. Quality, Audit & Compliance
- Perform quality checks and audits on processed claims; share feedback and track error trends
- Run root cause analysis (RCA) on errors and repeat issues; drive corrective and preventive actions
- Ensure adherence to SOPs, HIPAA, data privacy and security standards, and the Code of Conduct
- Support client and internal audits with accurate documentation
3. Training, Coaching & Onboarding
- Deliver classroom and on-the-job training for new joiners
- Support certification and proficiency phases; identify non-performers and run remediation
- Identify training needs and coach processors proactively
- Run knowledge refreshers on process, guideline and system changes
4. Documentation & Knowledge Management
- Create and maintain SOPs, job aids, process maps and FAQs; keep them current
- Verify and implement updates arising from client change orders
- Document task and workflow analysis clearly so the wider team can follow it
5. Operations & Delivery Support
- Support daily work allocation, inventory and priority management with the Team Lead, including backlog and ongoing volume
- Help the team meet APT, daily throughput and Day-5 TAT targets
- Participate in and contribute to daily huddles and status meetings
- Prepare ad hoc reports and MIS for service delivery needs
6. Client & Stakeholder Partnership
- Be the day-to-day process contact for client and onshore teams on claims queries and clarifications
- Build and leverage partnerships across shores
- Listen to stakeholders and keep communication clear across channels
7. Continuous Improvement
- Identify process delays, quality gaps and effort-reduction opportunities (e.g., checklists, validation checkpoints, automation candidates)
- Recommend and help implement solutions with Team Managers and the Practice Manager
- Support APT validation and productivity analysis during pilot and steady state
Qualifications & Experience
Education
- Bachelors degree (B.A, B.Com, B.Sc, BBA) or equivalent work experience
- Excluded as per Wipro standard: B.Tech/BE, LLB, B.Ed, B.Sc (IT), MCA, full-time MBA, unless exceptions are approved
Required Experience
- 58 years in claims or benefits operations, with at least 34 years in US Life, AD&D or Annuity claims
- US healthcare and benefits domain knowledge (e.g., beneficiary, policy, riders, eligibility, claim adjudication, HIPAA)
- Proven experience in complex claims, calculations and exception handling
- Prior experience in quality audits, training or coaching, or as a process trainer or SME
- Good MS Office skills (Excel, Word, PowerPoint); strong written and verbal communication
- Ability to coach and influence without formal authority
Preferred Experience
- Experience with claims platforms, workflow tools and reporting (MIS)
- Experience in transitions or knowledge transfer and SOP creation
- Exposure to RCA, Lean/Six Sigma or process improvement methods
- Prior BPO/outsourcing experience supporting a US client
Key Competencies
- Analytical and problem-solving ability
- Attention to detail and accuracy
- Ownership and accountability
- Clear communication and coaching skills
- Collaboration across shores
Work Conditions
- Shift: Primarily US time-zone hours (night shift IST), five days a week; flexibility to rotate shifts as business requires
- Work mode: Work from office [Location: Gurugram]
- Flexibility to extend hours occasionally to meet business or backlog needs
- Flexibility to support multiple teams and work types
