- 10-15 years in insurance, with at least 5 years in medical/health insurance or a TPA (claims,underwriting or provider network management).
- Detailed knowledge of the systems side of insurance: core policy administration, claims,underwriting and rating engines, provider portals, eligibility, payments and reinsurance, andhow these components integrate.
- 5+ years as a product owner, product manager or lead business analyst on insurance coresystem implementations, with at least two taken from vision through go-live.
- Proven track record leading business process re-engineering or operational transformation at aninsurer or TPA, with measurable results (e.g. faster turnaround, lower cost per claim, reducedfraud leakage).
- Practical experience applying automation and AI in insurance operations, such as auto-adjudication, document AI, or fraud and risk scoring.
- Hands-on knowledge of health claims adjudication: benefit structures, pre-authorisation,provider tariffs, coding of diagnoses and procedures (ICD-10, CPT or equivalent).
- Working knowledge of underwriting and rating, group/corporate schemes, and reinsurancebasics.
- Strong process modelling skills (BPMN or equivalent) and the ability to write specifications,business rules and acceptance criteria developers can build and QA can test.
- Confident presenting to and advising client executives, and leading workshops with operationalstaff.
- Bachelor's degree in insurance, actuarial science, finance, business, health sciences or a relatedfield.
- Fluent English, written and spoken.
Insurance Systems SME in agoura hills at Unknown Company
This position is listed as full time and onsite.