Insurance Claims Management AI Expert

Role Description

We are seeking a highly motivated and detail-oriented Insurance Claims Management AI Expert to join our growing team. This role sits at the intersection of insurance operations, data science, and artificial intelligence, with a strong focus on optimizing the end-to-end claims lifecycle. The ideal candidate will bring a blend of domain expertise in insurance claims and hands-on experience in deploying AI-driven solutions to enhance efficiency, accuracy, and customer experience.

• Transform traditional claims processes using AI and advanced analytics.
• Design, implement, and optimize intelligent systems across claims intake, investigation, and adjudication workflows.
• Work closely with cross-functional teams including underwriting, fraud detection, legal, and IT.

In claims intake:

• Develop and refine AI models for automated data extraction, classification, and triaging of claims from multiple sources.
• Improve turnaround time and minimize manual intervention.

For claims investigation:

• Leverage machine learning and predictive analytics to identify anomalies and detect potential fraud.
• Contribute to building intelligent workflows that prioritize high-risk claims.

In adjudication:

• Help design AI-assisted decision engines that recommend claim outcomes based on policy coverage, historical data, and risk profiles.
• Ensure consistency and compliance with regulatory standards.

Core Functional Expertise:

• Develop predictive models for accurate reserve setting and loss estimation using historical claims data.
• Design intelligent systems to identify subrogation opportunities early in the claims lifecycle.

Qualifications

• Bachelor’s or Master’s degree in Computer Science, Data Science, Actuarial Science, Insurance, or a related field.
• 2–8 years of experience in insurance claims management, analytics, or AI/ML roles.
• Strong understanding of claims lifecycle processes, including intake, investigation, adjudication, and recovery.
• Hands-on experience with machine learning frameworks (e.g., Python, TensorFlow, PyTorch) and data analysis tools.
• Familiarity with NLP, computer vision, or document processing tools for claims automation.
• Experience working with large datasets and building predictive models.

Requirements

• Knowledge of insurance regulations and compliance requirements.
• Experience with claims management systems and workflow automation tools.
• Strong problem-solving skills and ability to translate business needs into technical solutions.
• Excellent communication skills to collaborate with both technical and non-technical stakeholders.

Benefits

• Compensation: $100-$120 per hour (20 hours per week commitment).
• Job Type: Part-time / Contract.
• Location: US, UK, Canada, France, Portugal (remote).