Job Title: Subject Matter Expert (SME) – Railcard Eligibility & Appeals Specialist
1. Role Purpose
The Subject Matter Expert (SME) serves as the senior technical authority and escalation lead for national Railcard application evaluation within Salesforce CRM. Reporting directly to the Project Manager, the SME provides guidance and oversight to the team of Eligibility Assessors, ensuring consistent decision quality and rigorous standards across all application workflows.
Unlike general assessors, the SME specialises in evaluating complex, ambiguous, or borderline evidence—such as bespoke GP statements, consultant medical reports, and non-standard entitlement documentation. Additionally, the SME is responsible for adjudicating formal customer appeals and drafting clear, objective decision outcome communications, ensuring all scheme outcomes are fair, defensible, and fully compliant with eligibility frameworks.
2. Key Responsibilities2.1 Complex Evidence Evaluation & Borderline Decisioning
- Evaluate complex, ambiguous, or non-standard medical and entitlement evidence referred by Eligibility Assessors (including specialist medical consultant letters, GP clinical summaries, and complex benefit awards).
- Apply expert judgment to compare nuanced medical evidence against established eligibility matrices, ensuring fair and consistent outcomes.
- Serve as the final technical sign-off for complex or borderline application approvals.
2.2 Formal Customer Appeals & Reconsideration
- Manage, review, and determine formal applicant appeals against rejected Railcard applications.
- Conduct objective secondary reviews of disputed evidence, reassessing case files without bias.
- Draft comprehensive, polite, and legally defensible appeal outcome responses explaining technical decision rationales in plain English.
2.4 Salesforce Workflow & Escalation Management
- Actively manage and resolve escalated case queues within Salesforce CRM, maintaining strict service level agreement (SLA) turnaround times.
- Identify recurring evidence trends, common assessor queries, or system edge cases, liaising with the Project Manager to refine verification guidelines.
2.5 Compliance, Governance & Data Protection
- Maintain strict compliance with UK GDPR and the Data Protection Act 2018 when handling sensitive Special Category medical data.
- Ensure all evidence determinations conform to strict project non-disclosure agreements (NDAs) and national accessibility guidelines.
3. Person Specification3.1 Experience & Technical Expertise
- Essential: Proven track record in handling complex case escalations, formal disputes, or appeals determination.
- Essential: Proficient in using Salesforce CRM or similar enterprise case management systems to manage queues and track decisions.
- Desirable: Experience in evaluating medical evidence, disability benefits documentation, or complex entitlement criteria.
- Desirable: Deep understanding of disability documentation (e.g., PIP awards, DLA letters, Blue Badges, consultant reports, visual impairment certificates).
- Desirable: Experience working in a back-office operations environment within a regulated or accessibility-focused service.
3.2 Key Attributes & Competencies
- Advanced Medical/Evidence Literacy: Exceptional ability to interpret clinical language in GP/consultant letters and map impairment impacts against eligibility criteria.
- Analytical Objectivity: High sound judgment, capable of making firm, fair, and defensible decisions on complex cases.
- Communication & Technical Writing: Excellent written English skills, with the ability to articulate complex decision rationales clearly and professionally in formal appeal outcome letters.
- Mentoring & Team Leadership: Supportive, patient approach when coaching and guiding Eligibility Assessors on technical queries.
- High Focus & Data Security: Meticulous attention to detail and unwavering commitment to confidentiality and data protection standards.
4. Working Schedule & Shift Pattern
- Contracted Hours: 37.5 hours per week.
- Shift Schedule: 5 days per week scheduled between Monday and Saturday (operational daily window between 08:30 and 16:30).
- Saturday Requirement: Mandatory coverage on every other Saturday (alternate Saturdays) as part of the core operational rotation.
- Workplace: Office-based at Pentagon House, Derby.
Pay: £29,550.00 per year
Benefits:
- Additional leave
- Casual dress
- Company pension
- Free parking
- Health & wellbeing programme
- Life insurance
- On-site parking
- Sick pay
Work Location: In person
