US Health Insurance / Utilization Management Expert

US Health Insurance / Utilization Management Expert

• Work Mode: Remote
• Engagement: Part-time / Contract
• Commitment: 4–5 hours/day
• Openings: 3
• Pay Rate: ₹2,000–₹3,000/hour
• Start Date: Immediate

Role Overview

We are looking for experienced US Health Insurance / Utilization Management professionals to support an enterprise healthcare AI project. The role involves testing and reviewing AI-generated healthcare outputs, identifying errors, performing domain-level validation, and helping refine AI skills across multiple development iterations.

Required Expertise

• US healthcare / payer operations experience (Mandatory)
• Benefits & eligibility, deductibles, copays and coinsurance
• Prior authorization & utilization management
• Medical necessity and appeals preparation
• Formulary and commercial payer policies
• CMS NCD/LCD familiarity
• Healthcare claims/payer workflows
• Ability to review outputs for clinical, payer, regulatory, and accuracy requirements

Key Responsibilities

• Review and validate AI-generated healthcare responses.
• Identify payer, policy, and domain-specific errors.
• Perform error analysis and provide expert feedback.
• Support creation and validation of healthcare golden datasets.
• Validate AI outputs against real-world US healthcare practices and source evidence.

Candidate Verification

Shortlisted candidates will be required to provide:

• Resume/CV, LinkedIn Profile, Experience/Employment Verification, and Degree/Qualification Certificate.

Important: Relevant US healthcare experience is mandatory. Final compensation will depend on relevant professional experience and expertise.