SME (Subject Matter Expertise) - Life/Health claims

Antal International Network; Singapore; Remote; Confidential; Full time

Job summary

A leading InsurTech platform provider seeks an SME for Health Claims, based in Singapore. The candidate will define health claims workflows, validate coding, and collaborate with various stakeholders. With 6+ years in claims operations, this role requires both technical and business acumen.

Qualifications

• Minimum 6+ years of experience in life/health claims operations or consulting.
• Sound knowledge of claims processing workflows and adjudication.
• Ability to work with both business and technical stakeholders.

Responsibilities

• Participate in workshops with claims heads and operations teams.
• Define and document health claims flows from pre-authorization to payment.
• Assist in configuring rules for eligibility and benefit payouts.

Skills

Claims processing workflows

Adjudication logic

Fraud patterns knowledge

Medical codes understanding

Platform configuration

Good communication skills

Job description

SME (Subject Matter Expertise) - Life/Health claims

Hiring for a SME (Subject Matter Expertise) – Claims for an InsurTech platform provider

Company description:

Our client is an Indian headquartered InsurTech platform company focused on creating innovative software products to address the challenges of the global Insurance Industry. 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 including India, Singapore, Vietnam and Indonesia. They have raised more than 3 million USD through two rounds of VC funding and are looking to grow their number of offerings in health insurance, claims and underwriting.

• 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:

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