AI Insurance Process Specialist

Silna Health; New York (NY); Remote; USD 60,000 - 70,000; Full time

Benefits offered by this job

Remote role

Competitive benefits package

401(k)

Unlimited PTO

Job summary

Silna Health, Inc. is seeking a curious AI Insurance Process Specialist to map insurance workflows and QA AI outputs related to payor rules.

You will review AI outputs, annotate documents, and translate payor requirements into executable workflows for prior authorization, eligibility verification, and benefit checks. You will collaborate with healthcare operations to execute payor change requests, investigate payer rules, and document sources.

Qualifications

• Strong analytical skills and attention to detail, with the ability to spot inconsistencies and investigate their causes.
• Ability to turn ambiguous requirements into clear steps, decision points, and exceptions.
• A systems mindset: you understand how steps in a workflow connect and how a change in one area affects downstream work.
• Strong research skills and sound judgment about what is verified, what is assumed, and what needs clarification.
• Clear written and verbal communication, including the ability to document precise, repeatable instructions.
• Ability to execute on tasks in an efficient manner, owning the outcome.
• Curiosity about AI, healthcare operations, and insurance workflows.
• Strong organizational skills and the ability to work independently and collaborate effectively in a remote environment.
• Experience with healthcare administration, prior authorization, and insurance verification is helpful.
• Familiarity with Python, SQL, or AI tools is a bonus.

Responsibilities

• Evaluate AI performance.
• Review information extracted from healthcare documents and actions taken by AI assistants during online and phone workflows. Identify errors, missing information, and cases that require human review.
• Annotate documents and forms.
• Label fields, map information to submission requirements, and create examples that help teams develop and evaluate AI systems.
• Build clear workflows and decision trees.
• Translate insurance requirements into step-by-step processes for prior authorization, eligibility verification, and benefit checks.
• Research insurance requirements.
• Investigate payer rules, required documentation, submission methods, and follow-up procedures. Document sources and flag unclear or conflicting guidance.
• Maintain practical documentation.
• Create and update process guides, decision trees, and quality standards as requirements change.
• Measure improvements.
• Help define and track metrics such as accuracy, completeness, successful submissions, and the frequency of human intervention.
• Execute on insurance change tasks in our system in a timely manner.
• Fulfill daily quota of AI configuration changes in our system accurately.

Skills

Analytical thinking

Attention to detail

Systems thinking

Research skills

Clear communication

Python

SQL

AI tools

Tools

Python

SQL

AI tools

Job description

Silna Health is looking for a curious, detail-oriented AI Insurance Process Specialist to map

insurance workflows and QA AI outputs related to insurance rules. You’ll review AI outputs and

translate payor requirements into clear, executable workflows.

This role combines research, quality assurance, and task execution. You’ll work closely with healthcare operations teams to execute payor change requests in our platform and also collaborate in understanding how insurance workflows work. Identify where automation needs improvement is also part of the role. You will need strong analytical skills, careful judgment, and an interest in how AI can solve practical problems.

In this role, you will:

• Evaluate AI performance.
• Review information extracted from healthcare documents and actions taken by AI assistants during online and phone workflows. Identify errors, missing information, and cases that require human review.
• Annotate documents and forms.
• Label fields, map information to submission requirements, and create examples that help teams develop and evaluate AI systems.
• Build clear workflows and decision trees.
• Translate insurance requirements into step-by-step processes for prior authorization, eligibility verification, and benefit checks.
• Research insurance requirements.
• Investigate payer rules, required documentation, submission methods, and follow-up procedures. Document sources and flag unclear or conflicting guidance.
• Maintain practical documentation.
• Create and update process guides, decision trees, and quality standards as requirements change.
• Measure improvements.
• Help define and track metrics such as accuracy, completeness, successful submissions, and the frequency of human intervention.
• Execute on insurance change tasks in a timely manner.
• Fulfill daily quota of AI configuration changes in our system accurately.

You’ll be a strong fit if you have:

Strong analytical skills and attention to detail, with the ability to spot inconsistencies and

investigate their causes.

The ability to turn ambiguous requirements into clear steps, decision points, and exceptions.

A systems mindset: you understand how steps in a workflow connect and how a change in

one area affects downstream work.

Strong research skills and sound judgment about what is verified, what is assumed, and

what needs clarification.

Clear written and verbal communication, including the ability to document precise,

repeatable instructions.

Ability to execute on tasks in an efficient manner, owning the outcome.

Curiosity about AI, healthcare operations, and insurance workflows.

Strong organizational skills and the ability to work independently and collaborate effectively in a remote environment.

We welcome applicants from technical and nontechnical backgrounds, including recent graduates.Experience with healthcare administration, prior authorization, and insurance verification is helpful. Familiarity with Python, SQL, or AI tools is a bonus.

Silna Health helps healthcare organizations prevent administrative issues before care is delivered. We simplify prior authorizations, eligibility verification, and benefit checks so providers can spend less time navigating insurance requirements and patients can access care sooner. We work across behavioral health, physical health, ambulatory care, and post-acute care, and are backed by Accel and Bain Capital Ventures.

We offer:

• An annual salary of 60,000-70,000 depending on experience.
• A remote role with a collaborative, motivated team.
• The opportunity to build expertise at the intersection of healthcare and AI.
• Work that directly supports patient access to care.
• A competitive benefits package, 401(k), and unlimited PTO.