Insurance Systems SME

10-15 years in insurance, with at least 5 years in medical/health insurance or a TPA (claims, underwriting or provider network management). Detailed knowledge of the systems side of insurance: core policy administration, claims, underwriting and rating engines, provider portals, eligibility, payments and reinsurance, andhow these components integrate. 5+ years as a product owner, product manager or lead business analyst on insurance coresystem implementations, with at least two taken from vision through go-live. Proven track record leading business process re-engineering or operational transformation at aninsurer or TPA, with measurable results (e.g. faster turnaround, lower cost per claim, reducedfraud leakage). Practical experience applying automation and AI in insurance operations, such as auto-adjudication, document AI, or fraud and risk scoring. Hands-on knowledge of health claims adjudication: benefit structures, pre-authorisation, provider tariffs, coding of diagnoses and procedures (ICD-10, CPT or equivalent). Working knowledge of underwriting and rating, group/corporate schemes, and reinsurancebasics. Strong process modelling skills (BPMN or equivalent) and the ability to write specifications, business rules and acceptance criteria developers can build and QA can test. Confident presenting to and advising client executives, and leading workshops with operationalstaff. Bachelor's degree in insurance, actuarial science, finance, business, health sciences or a relatedfield. Fluent English, written and spoken.