Insurance Claims Management AI Expert

• 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

You will play a critical role in transforming traditional claims processes using AI and advanced analytics. Your primary responsibilities will include designing, implementing, and optimizing intelligent systems across claims intake, investigation, and adjudication workflows. You will work closely with cross-functional teams including underwriting, fraud detection, legal, and IT to ensure seamless integration of AI models into operational environments.

In claims intake, you will develop and refine AI models for automated data extraction, classification, and triaging of claims from multiple sources such as documents, images, and customer submissions. Improving turnaround time and minimizing manual intervention will be a key objective.

For claims investigation, you will leverage machine learning and predictive analytics to identify anomalies, detect potential fraud, and support decision-making. You will contribute to building intelligent workflows that prioritize high-risk claims and assist adjusters with actionable insights.

In adjudication, you will 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.

• Reserve Setting and Loss Estimation:
  Develop predictive models for accurate reserve setting and loss estimation using historical claims data, actuarial inputs, and real-time indicators. Continuously refine models to improve forecasting accuracy and reduce financial leakage.
• Subrogation and Recovery:
  Design intelligent systems to identify subrogation opportunities early in the claims lifecycle. Implement AI tools to track recovery potential, automate documentation, and improve recovery rates through data-driven insights.

• 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