Insurance Specialist - Fully Remote | Upto $1450 Part-time

Role Responsibilities

• Review and evaluate AI-generated outputs related to plan benefit design, coverage determination, claims adjudication, and medical necessity criteria.
• Create realistic scenarios based on health insurance workflows such as prior authorization decisions, explanation of benefits reviews, formulary exceptions, network adequacy assessments, and regulatory audits.
• Annotate, label, and validate data across health insurance use cases, including ICD coding accuracy, payer policy interpretation, and managed care utilization review.
• Provide structured feedback on AI accuracy in areas such as federal and state insurance regulations (ACA, ERISA, HIPAA, CMS guidelines), payer contracting, and industry-specific terminology.
• Collaborate asynchronously with research teams to refine evaluation frameworks for health insurance AI.

Qualifications

• Must Have: 3+ years of professional experience at a health plan, benefits administrator, TPA, PBM, or managed care organization.
• Background in claims processing and adjudication (medical, dental, pharmacy), medical underwriting or actuarial analysis for health plans, utilization management or care management (UM/CM), benefits administration (group, individual, Medicare Advantage, Medicaid managed care), regulatory compliance, product development, or government programs (ACA, Part D, CHIP).
• Strong analytical thinking and ability to translate health plan workflows into structured evaluation tasks.
• Clear written communication and attention to detail.

Preferred

• Professional designations such as CEBS, AHIP, HIAA, Fellow/ASA actuarial credentials.

Pay and Benefits

Compensation: Competitive and based on task quality.
Performance Bonus: Top performers receive a weekly bonus incentive.
Hourly Opportunity: Top performers may transition to an hourly compensation model based on sustained quality and throughput.