Insurance Claims Management AI Expert

About the role

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.

Responsibilities

• Design, implement, and optimize intelligent systems across claims intake, investigation, and adjudication workflows.
• Develop and refine AI models for automated data extraction, classification, and triaging of claims from multiple sources such as documents, images, and customer submissions.
• Leverage machine learning and predictive analytics to identify anomalies, detect potential fraud, and support decision-making during claims investigation.
• Contribute to building intelligent workflows that prioritize high-risk claims and assist adjusters with actionable insights during adjudication.
• Help design AI-assisted decision engines that recommend claim outcomes based on policy coverage, historical data, and risk profiles, ensuring consistency and compliance with regulatory standards.
• Develop predictive models for accurate reserve setting and loss estimation using historical claims data, actuarial inputs, and real-time indicators.
• Design intelligent systems to identify subrogation opportunities early in the claims lifecycle and implement AI tools to track recovery potential, automate documentation, and improve recovery rates through data-driven insights.

Requirements

• 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

Qualifications

• 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