Domain Expert | Insurance: Claims Processing & Coverage
Core
US insurance expert mapping claims processes and coverage interpretation into executable rules for AI agents.
Role type
Senior Domain Expert (Insurance Claims & Coverage)
Builds
Executable rulebooks for AI decision-making in insurance
Domain
US Insurance (Claims, Coverage, Compliance)
Deliverable
production ML models
Required skills
Claims management, Coverage analysis, US insurance regulation, Policy structure, Process documentation, Audit of insurance decisions, Fraud detection, SIU investigations
Preferred skills
Underwriting, Policy administration, Billing, Reinsurance, Reserving, Broker management, Insurtech experience, Rules engines, AI governance
Technologies
Guidewire, Rules engines
Responsibilities
Map claims processes end to end, Analyze policy forms and claims manuals, Translate coverage interpretation into structured rules, Build test cases and golden-label datasets, Review agent outputs against expert decisions, Work with customer leaders to ratify rulebooks