AI Insurance Process Specialist

The role

This person will build, maintain, and update insurance workflows and QA AI outputs related to insurance rules. They will review AI outputs, translate payor requirements into workflows, and research insurance requirements.

What you will do

• Evaluate AI performance.
• Review information extracted from healthcare documents and actions taken by AI assistants.
• Audit AI agent outputs against ground-truth medical records and payor guidelines.
• Annotate documents and forms.
• Build clear workflows and decision trees.
• Research insurance requirements.
• Maintain practical documentation.
• Measure improvements.
• Execute on insurance change tasks in a timely manner.
• Fulfill daily quota of AI configuration changes in our system accurately.

Required qualifications

• Strong analytical skills and attention to detail.
• Ability to turn ambiguous requirements into clear steps, decision points, and exceptions.
• A systems mindset.
• Strong research skills and sound judgment.
• Clear written and verbal communication.
• Ability to execute on tasks in an efficient manner.
• Curiosity about AI, healthcare operations, and insurance workflows.
• Strong organizational skills and the ability to work independently and collaborate effectively in a remote environment.

Nice to have

• Experience with healthcare administration, prior authorization, and insurance verification
• Familiarity with AI prompting, Python, SQL, or AI tools

Benefits

• A competitive benefits package
• 401(k)
• unlimited PTO

About the company

Silna Health helps healthcare organizations prevent administrative issues before care is delivered. They simplify prior authorizations, eligibility verification, and benefit checks.