Domain Expert – Insurance, Claims Processing, Coverage

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

🔒 Insurance

👻 Ghost score 15%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Factify

WebsiteLinkedInAll Job Openings

1 - 10 employees

⚡ Productivity

☁️ SaaS

Productivity • SaaS

Factify is a software development company focused on innovating and enhancing document management and processing. With a tagline of 'The Future of Documents,' Factify is dedicated to transforming how digital documents are created, stored, and utilized, likely employing advanced technologies to streamline workflows and improve efficiency in document-related tasks.

📋 Description

• 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