Claims Consultant

1 day ago

Hyderabad, India Scry AI Full time

Position: Claims Clerk – Subject Matter Expert (SME) Location: India (Remote) Employment Type: Full-Time Schedule: Monday to Friday, Day Shift Experience: 2+ years in insurance/TPA claims operations with SME-level proficiency Scry AI is a research-led enterprise AI company that builds intelligent platforms to drive efficiency, insight, and compliance. Our platforms Collatio®, Auriga®, and Concentio® help insurers and TPAs automate document intake, validation, reconciliation and deliver real-time intelligence. As a Claims Clerk (SME), you’ll be the go-to expert for end-to-end claims administration, standardizing intake, verification, and adjudication preparation while improving accuracy, turnaround time, and audit readiness. You’ll translate domain rules into clear SOPs, tagging schemas, and validation checklists that power Scry AI products (Collatio® for document intelligence and Auriga® for knowledge assistance), and you’ll coach the team on best practices. Own SOPs, checklists, and quality gates for claims intake, validation, and file preparation. • Run QC audits, measure TAT/accuracy, and drive corrective actions and RCA/postmortems. Claims Processing (SME Hands-On) • verify policyholder/provider data, coverage terms, and completeness. • Extract and validate structured fields (dates, amounts, codes); Partner with product/data teams to design field taxonomies, label policies, and validation rules. • Use Collatio® to auto-capture claim fields, BOM-like itemizations, and EOB details; Compliance, Audit & Fraud Vigilance • Ensure documentation meets regulatory/privacy standards (IRDAI; Maintain audit trails, revision histories, and communication records. • Identify fraud/abuse indicators; Knowledge & Training • Act as SME on customer calls, RFIs, and process transition/wrap-up meetings. 2+ years in claims operations (health, motor, property) at an insurer/TPA/BPO. • Strong command of policy terms, EOBs; health lines: familiarity with CPT/ICD codes. • expert in documentation and QC. • Proficiency with spreadsheets, PDFs, claims/CRM systems; Experience with AI/IDP tools (e.g., Exposure to fraud frameworks and evidence handling. • Treats every claim as data: structured, validated, and audit-ready. • Uplifts teams through standards, training, and measurable quality improvements. • Comfortable collaborating with product/data engineers to make automation stick. Tip for Candidates

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