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Insurance Architect

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Insurance Architect in USA new

  • New York, NY

Responsibilities

  • Build and own the insurance rules engine that represents how healthcare plans, carriers, and layered coverage operate.
  • Convert insurance rules and eligibility responses into accurate patient pricing during onboarding.
  • Design workflows for unknown or ambiguous insurance responses and determine how exceptions are handled.
  • Create a feedback loop that uses claims, denials, surprise bills, and payment data to improve estimates and rules.
  • Determine where AI should assist with eligibility responses, plan research, and rule proposals while keeping deterministic logic where required.
  • Design approval processes for insurance rule changes and reduce manual review to true exceptions.
  • Wrangle data, prototype workflows, and ship working initial solutions before requesting engineering resources.

Requirements

  • A few years of experience applying software and systems thinking to messy real-world rules, such as in forward-deployed engineering, BizOps, product operations, healthtech, fintech, payments, insurance, or a similar environment.
  • Experience converting tribal knowledge held by individuals into a system that can operate without constant personal intervention.
  • Ability to break ambiguous problems into inputs, rules, exceptions, and failure modes and prioritize the highest-impact cases.
  • Hands-on builder mindset with a willingness to work directly with data, prototype workflows, and ship practical first versions.
  • Exceptional attention to detail and accountability for accurate financial and patient-facing outcomes.
  • Relentlessness in investigating raw eligibility responses and learning complex insurance behavior; prior insurance expertise is not required.

Benefits

  • In-person work in New York City.
  • Opportunity to work on a high-impact healthcare problem with substantial ownership and increasingly challenging responsibilities.
  • The company has raised $34M from Accel and Bain Capital Ventures and works with healthcare partners including Weill Cornell, NYU Langone, UCSF, USC, and Mount Sinai.

Salary: $150k - $210k/yr

Hera

Hera builds a senior-care coordination platform and service that assigns a dedicated Hero to help families manage needs outside the doctor’s office. Heroes educate, coordinate, and advocate for older adults and their caregivers, and the service is covered by Original Medicare. The privately held ...

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