AI Insurance Process Specialist

Silna Health

3d•$60,000 - $70,000•Remote

About The Position

Silna Health is seeking a curious, detail-oriented AI Insurance Process Specialist to map insurance workflows and quality-check AI outputs related to insurance rules. The role reviews AI outputs and translates payer requirements into clear, executable workflows. It combines research, quality assurance, and task execution, including working with healthcare operations teams to carry out payer change requests in the platform, understand insurance workflows, and identify opportunities to improve automation. The specialist evaluates information extracted from healthcare documents and actions taken by AI assistants during online and phone workflows; annotates documents and forms; researches payer requirements; and creates and maintains workflow guides, decision trees, and quality standards. The role also helps define and track performance metrics and completes daily quotas of AI configuration changes accurately and on time. Silna Health helps healthcare organizations prevent administrative issues before care is delivered by simplifying prior authorizations, eligibility verification, and benefit checks. It works across behavioral health, physical health, ambulatory care, and post-acute care, and is backed by Accel and Bain Capital Ventures.

Requirements

Strong analytical skills and attention to detail, including the ability to spot inconsistencies and investigate their causes.
Ability to turn ambiguous requirements into clear steps, decision points, and exceptions.
A systems mindset and understanding of how workflow steps connect and how changes affect downstream work.
Strong research skills and sound judgment about what is verified, assumed, or in need of clarification.
Clear written and verbal communication, including the ability to document precise, repeatable instructions.
Ability to execute tasks efficiently and own the outcome.
Curiosity about AI, healthcare operations, and insurance workflows.
Strong organizational skills and ability to work independently and collaborate effectively in a remote environment.

Nice To Haves

Experience with healthcare administration, prior authorization, or insurance verification.
Familiarity with Python, SQL, or AI tools.

Responsibilities

Evaluate AI performance by reviewing information extracted from healthcare documents and actions taken by AI assistants during online and phone workflows; identify errors, missing information, and cases requiring human review.
Annotate documents and forms by labeling fields, mapping information to submission requirements, and creating examples to support AI system development and evaluation.
Translate insurance requirements into step-by-step workflows and decision trees for prior authorization, eligibility verification, and benefit checks.
Research payer rules, required documentation, submission methods, and follow-up procedures; document sources and flag unclear or conflicting guidance.
Create and update process guides, decision trees, and quality standards as requirements change.
Help define and track metrics such as accuracy, completeness, successful submissions, and frequency of human intervention.
Execute insurance change tasks and complete the daily quota of AI configuration changes accurately and in a timely manner.