The Health Insurance Subject Matter Expert will play a pivotal role in shaping the core functionality of a next-generation insurance platform. This individual will leverage deep industry expertise to ensure that digital workflows accurately reflect real-world health insurance operations, from underwriting and claims processing to billing and policy renewals. The expert will work closely with product and engineering teams to translate complex business processes into actionable technical specifications, ensuring compliance, scalability, and operational efficiency. This role is critical in driving automation, reducing manual intervention, and enabling straight-through processing across key insurance functions.
Responsibilities
- Provide expert guidance to the product team throughout the development lifecycle, ensuring features reflect real-world health insurance operations.
- Convert core insurance processes—including underwriting, claims, billing, policy administration, and renewals—into detailed product specifications and functional documentation.
- Define and validate business rules, decision logic, and workflow automation to ensure system outputs are accurate, compliant, and operationally viable.
- Take part in User Acceptance Testing to verify that system functionality, workflows, and logic meet business requirements.
- Design digital workflows for maximum Straight-Through Processing, reducing manual intervention through intelligent automation.
- Establish automation rules, decision frameworks, and exception handling aligned with actual insurance practices.
- Ensure digital systems accurately mirror real-world business operations, embedding scalability and efficiency into product design.
- Convert regulatory standards and policy requirements into enforceable system logic and product features.
- Research market trends and competitor offerings to identify gaps and opportunities in global health insurance product development.
- Serve as a liaison between business, product, and engineering teams, translating needs into actionable technical requirements.
- Inform product roadmap planning by providing domain-specific insights and prioritization input.
- Collaborate with clients, partners, and insurers to gather feedback and validate product direction.
- Support go-to-market, sales, and pre-sales initiatives by providing deep functional expertise when required.
Requirements
- Over 12 years of experience in the insurance sector with comprehensive exposure to end-to-end operations.
- Minimum of 5 years focused on health insurance, including in-depth knowledge of the full product lifecycle.
- Professional experience across at least two health insurance functions such as underwriting, claims, pricing, policy administration, renewals, billing, or endorsements.
- Proven ability to collaborate with product, technology, and business teams in fast-moving environments.
- Practical mindset with a track record of turning domain expertise into functional product features.
- Strong systems thinking skills, with the ability to map processes, identify automation opportunities, and convert rules into logic.
- Analytical and forward-looking approach, capable of spotting hidden gaps and proposing actionable solutions.
- Excellent communication skills, able to convey complex insurance concepts clearly to both technical and non-technical stakeholders.
- Demonstrated ability to engage confidently with clients and external stakeholders, even without a formal sales background.
Nice to Have
- Experience in additional insurance lines such as life or property and casualty (P&C).
- Hold a Chartered Insurance Institute (CII) Certificate or equivalent credential.
- Tech-savvy background with involvement in digital transformation projects or experience with insurance systems.
- Prior work in insurtech as a subject matter expert or consultant is highly valued.
- Exposure to international markets or global health insurance products.
Benefits
- Competitive salary
- Fully remote work environment
- Opportunity to work with cutting-edge technology in the insurtech industry
- Comprehensive health, dental, and vision insurance coverage
- Generous paid time off and flexible vacation policy
- Professional development stipend for certifications and courses
- Annual company retreats and team-building events
Compensation
Competitive salary commensurate with experience, including performance-based bonuses and equity options.
Work Arrangement
Fully remote position with flexible working hours; occasional travel may be required for team meetings or client engagements.
Team
You will join a cross-functional team of product managers, engineers, and domain experts dedicated to transforming the insurance industry through innovative technology solutions. Collaboration is highly valued, and input from subject matter experts directly influences product direction and development priorities.
Additional Information
- This role is ideal for someone passionate about modernizing legacy insurance systems.
- Candidates must be authorized to work remotely for a U.S.-based company.
- The company provides all necessary equipment and software for remote work.
- Regular virtual check-ins and performance reviews ensure continuous growth and alignment.
- The position may involve working across multiple time zones to support global clients.
