Domain Expert – Insurance, Claims Processing, Coverage

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

📋 Description

• Outline the claims processes comprehensively: initial notice of loss, triage, coverage verification, investigation, adjudication, reserving, settlement, and recovery.

• Document other essential insurance processes as customer requirements emerge, utilizing practical knowledge of their operations.

• Examine policy documents, endorsements, exclusions, and claims manuals.

• Detect inconsistencies and ambiguities among documents and between documents and actual practices.

• Convert coverage interpretations and authority limitations into organized rules, including SIU and fraud indicators, escalation triggers, and state-mandated handling timelines.

• Create test cases and golden-label datasets that encompass covered, not covered, and refer decisions with supporting evidence across property, auto, health, and liability.

• Evaluate agent outputs against decisions made by seasoned insurance professionals and document failure modes.

• Collaborate with customer leaders to validate and sustain the rulebook over time.

⛳️ Requirements

• Over 10 years of experience in insurance at a US carrier, TPA, or MGA, with extensive expertise in claims management, claims operations, coverage analysis, or insurance compliance.

• Profound knowledge of policy structures, exclusions, conditions, and subrogation.

• In-depth understanding of US insurance regulations: state unfair claims settlement practices, NAIC model laws, and state department of insurance requirements.

• Experience in process documentation, quality assurance, or auditing of insurance decisions.

• Ability to distinguish between what the policy states and what the organization implements, explaining both clearly.

• Willingness to have regular overlap with the Tel Aviv team.

• Excellent written and verbal communication skills with insurance leaders, executives, and engineers.

• Strongly preferred: hands-on experience in additional critical insurer processes, including underwriting and risk selection; policy administration, endorsements, and renewals; billing, premium collection, and cancellations; fraud detection and SIU investigations; subrogation, salvage, and recovery; reinsurance and ceded claims; reserving and actuarial processes; regulatory filings, market conduct, and compliance; broker and agent management; customer service, complaints, and litigation management.

• Preferred: experience at an insurtech, in a claims-automation program, or in a Big 4 insurance practice.

• Preferred: familiarity with rules engines, core insurance platforms like Guidewire, or AI governance.

• Preferred: CPCU, AIC, ARM, or equivalent credentials.

🏝️ Benefits

• Option for remote work within the United States.

• Regular collaboration with the Tel Aviv team during US Eastern morning hours.