AI Insurance Process Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess the performance of AI by analyzing data extracted from healthcare documents and the actions taken by AI assistants during online and phone workflows.

• Detect errors, missing information, and situations that necessitate human review.

• Annotate documents and forms, label fields, align information with submission requirements, and generate examples for AI development and assessment.

• Develop workflows and decision trees for prior authorization, eligibility verification, and benefit checks.

• Investigate payer regulations, necessary documentation, submission methods, and follow-up procedures.

• Record sources and highlight ambiguous or contradictory guidance.

• Create and revise process guides, decision trees, and quality standards.

• Establish and monitor metrics such as accuracy, completeness, successful submissions, and frequency of human intervention.

• Accurately implement insurance change tasks and meet the daily target for AI configuration modifications.

• Work collaboratively with healthcare operations teams to enhance automation.

• Assist healthcare organizations by streamlining prior authorizations, eligibility verification, and benefit checks.

⛳️ Requirements

• Excellent analytical abilities and attention to detail, with a knack for identifying inconsistencies and probing their origins.

• Capability to transform vague requirements into well-defined steps, decision points, and exceptions.

• A systems-oriented mindset with an understanding of workflow interdependencies.

• Strong research skills and sound judgment regarding what should be verified, assumed, or clarified.

• Exceptional written and verbal communication skills.

• Ability to create clear, repeatable instructions in documentation.

• Proficiency in executing tasks efficiently and taking ownership of outcomes.

• An inquisitive nature about AI, healthcare operations, and insurance workflows.

• Strong organizational capabilities.

• Ability to work autonomously and collaborate effectively in a remote setting.

• Candidates from both technical and non-technical backgrounds, including recent graduates, are welcome to apply.

• Experience in healthcare administration, prior authorization, and insurance verification is advantageous.

• Familiarity with Python, SQL, or AI tools is a plus.

• Must possess legal authorization to work in the United States.

• Employment eligibility verification must be completed upon hiring.

🏝️ Benefits

• A remote position within a collaborative and driven team.

• The chance to develop expertise at the crossroads of healthcare and AI.

• Work that contributes directly to patient access to care.

• A competitive benefits package.

• 401(k) plan.

• Unlimited paid time off (PTO).