Domain Expert – Insurance, Claims Processing, Coverage
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Job Description
US insurance domain expert mapping claims and coverage processes for Factify’s auditable AI rulebooks. Translating carrier judgment into testable rules, datasets, and validated agent decisions.
Responsibilities:
- Map claims processes end to end: first notice of loss, triage, coverage verification, investigation, adjudication, reserving, settlement and recovery
- Map other critical insurance processes as customer needs arise, using practical experience of how they run
- Analyze policy forms, endorsements, exclusions and claims manuals
- Identify contradictions and ambiguity between documents and between documents and practice
- Translate coverage interpretation and authority limits into structured rules, including SIU and fraud indicators, escalation triggers and state-mandated handling timelines
- Build test cases and golden-label datasets covering covered, not covered and refer decisions with evidence across property, auto, health and liability
- Review agent outputs against decisions made by experienced insurance professionals and document failure modes
- Work with customer leaders to ratify and maintain the rulebook over time
Requirements:
- 10+ years in insurance at a US carrier, TPA or MGA, with deep expertise in claims management, claims operations, coverage analysis or insurance compliance
- Deep understanding of policy structure, exclusions, conditions and subrogation
- Deep understanding of US insurance regulation: state unfair claims settlement practices, NAIC model laws, and state department of insurance requirements
- Experience with process documentation, quality assurance or audit of insurance decisions
- Ability to separate what the policy says from what the organization actually does, and explain both clearly
- Availability for regular overlap with the Tel Aviv team
- Clear written and verbal communication with insurance leaders, executives and engineers
- Strong advantage: hands-on experience in additional critical insurer processes, including underwriting and risk selection; policy administration, endorsements and renewals; billing, premium collection and cancellations; fraud detection and SIU investigations; subrogation, salvage and recovery; reinsurance and ceded claims; reserving and actuarial processes; regulatory filings, market conduct and compliance; broker and agent management; customer service, complaints and litigation management
- Nice to have: experience at an insurtech, in a claims-automation program or in a Big 4 insurance practice
- Nice to have: exposure to rules engines, core insurance platforms such as Guidewire, or AI governance
- Nice to have: CPCU, AIC, ARM or equivalent credentials
Benefits:
- Remote work in the United States
- Regular overlap with the Tel Aviv team during US Eastern morning hours
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