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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive expertise in claims management and operations within the insurance sector, with a strong focus on policy analysis, regulatory compliance, and process documentation. Capable of translating complex coverage interpretations into structured rules while ensuring alignment with industry standards and practices.
Highest-signal resume keywords
Claims Management ExpertisePolicy Structure AnalysisUS Insurance Regulation KnowledgeProcess Documentation ExperienceClear Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims OperationsCoverage AnalysisQuality AssuranceFraud DetectionSubrogationRisk SelectionRegulatory FilingsAudit of Insurance DecisionsProcess MappingTest Case Development
Soft Skills
Clear Written CommunicationVerbal CommunicationCollaboration with Leaders
Tools & Technologies
GuidewireRules EnginesCore Insurance Platforms
Certifications & Qualifications
CPCUAICARM
Industry Keywords
Insurance ComplianceClaims Settlement PracticesNAIC Model LawsState Department of Insurance RequirementsCustomer Service Management
Tech Stack
Tools & technologiesGuidewire
About the role
Key responsibilities & impact- Map claims processes end to end: first notice of loss, triage, coverage verification, investigation, adjudication, reserving, settlement and recovery
- Map other critical insurance processes as customer needs arise, using practical experience of how they run
- Analyze policy forms, endorsements, exclusions and claims manuals
- Identify contradictions and ambiguity between documents and between documents and practice
- Translate coverage interpretation and authority limits into structured rules, including SIU and fraud indicators, escalation triggers and state-mandated handling timelines
- Build test cases and golden-label datasets covering covered, not covered and refer decisions with evidence across property, auto, health and liability
- Review agent outputs against decisions made by experienced insurance professionals and document failure modes
- Work with customer leaders to ratify and maintain the rulebook over time
Requirements
What you’ll need- 10+ years in insurance at a US carrier, TPA or MGA, with deep expertise in claims management, claims operations, coverage analysis or insurance compliance
- Deep understanding of policy structure, exclusions, conditions and subrogation
- Deep understanding of US insurance regulation: state unfair claims settlement practices, NAIC model laws, and state department of insurance requirements
- Experience with process documentation, quality assurance or audit of insurance decisions
- Ability to separate what the policy says from what the organization actually does, and explain both clearly
- Availability for regular overlap with the Tel Aviv team
- Clear written and verbal communication with insurance leaders, executives and engineers
- Strong advantage: hands-on experience in additional critical insurer processes, including underwriting and risk selection; policy administration, endorsements and renewals; billing, premium collection and cancellations; fraud detection and SIU investigations; subrogation, salvage and recovery; reinsurance and ceded claims; reserving and actuarial processes; regulatory filings, market conduct and compliance; broker and agent management; customer service, complaints and litigation management
- Nice to have: experience at an insurtech, in a claims-automation program or in a Big 4 insurance practice
- Nice to have: exposure to rules engines, core insurance platforms such as Guidewire, or AI governance
- Nice to have: CPCU, AIC, ARM or equivalent credentials
Benefits
Comp & perks- Remote work in the United States
- Regular overlap with the Tel Aviv team during US Eastern morning hours