Essential Duties & Responsibilities:

AI Strategy and Business Applications

• Identify business process and workflows where AI, automation, and advanced analytics can provide measurable value.
• Partner with claims, operations, Finance, HR, client service, IT, and leadership teams to understand business needs and identify AI opportunities.
• Evaluate emerging AI technologies and determine their applicability to TPA operations.
• Develop business cases and recommendations for AI initiatives, including expected benefits, costs, risks, and implementation requirements.
• Maintain an inventory and prioritize AI opportunities across the company.

Claims and Operational Analytics

• Analyze claims and operational data to identify trends, patterns, inefficiencies, and opportunities for improvement.
• Develop AI-assisted solutions to support claims professionals with activities such as:
• Claim file summarization
• Document classification and extraction
• Correspondence drafting
• Medical or claims documentation review
• Diary and workflow prioritization
• Identification of missing information
• Quality assurance reviews
• Claims trend identification
• Workload and productivity analysis
• Develop dashboards, reports, and other analytical tools that provide actionable information to management.
• Assist in identifying opportunities to improve claims cycle time, quality, accuracy, consistency, and client focused services.

AI Implementation and Optimization

• Participate in the design, testing, implementation, and monitoring of AI solutions.
• Develop and refine effective prompts, workflows, and AI use cases.
• Conduct testing to evaluate the accuracy, consistency, reliability, and usefulness of AI-generated outputs.
• Establish appropriate human-review processes for AI-assisted activities.
• Monitor implemented AI solutions and recommended enhancements based on performance and user feedback.
• Document AI processes, workflows, controls, and operating procedures.

Data Governance, Risk and Compliance

• Support responsible and secure use of AI involving confidential employee, client, claimant, medical, financial, and other sensitive information.
• Partner with IT, information Security, Legal, Compliance, and other stakeholders to establish appropriate AI controls.
• Help ensure AI applications are used consistently with company policies, contractual obligations, regulatory requirements, and applicable privacy standards.
• Identify potential risks associated with AI outputs, including inaccurate information, bias, inappropriate recommendations and data-security concerns.
• Maintain documentation of AI models, tools, use cases, testing, controls, and approved applications.

Training and Change Management

• Facilitate workshops, demonstrations, and adoption initiatives to encourage effective utilization of approved AI solutions.
• Develop training materials, guidelines, job aids, and best practices.
• Serve as an internal resource for employees seeking to incorporate AI into their work.
• Partner with managers to identify opportunities for employees to eliminate repetitive administrative work and focus more time on higher-value activities.
• Promote responsible adoption of AI while emphasizing appropriate human judgement and accountability.

Continuous Improvement

• Apply process-improvement methodologies to evaluate current workflows and determine where AI or automation can eliminate unnecessary steps, reduce duplication, or improve quality.
• Establish measurable performance indicators for AI initiatives.
• Track and report results, including productivity improvements, time savings, quality improvements, cost savings, and employee/client impact.
• Participate in Corporate-wide process improvement initiatives and other strategic projects. 

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

Required: 

• Bachelor's degree in business analytics, data analytics, information systems, computer science, business administration, insurance, or related field; equivalent experience may be considered.
• Minimum of 4 years of experience in analytics, business process improvement, technology, insurance operations, or a related field.
• Demonstrated experience using generative AI tools and/or automation technologies.
• Strong written and verbal communication skills with the ability to explain complex concepts to non-technical audiences.
• Strong attention to detail and ability to manage multiple projects.
• Understanding of both AI capabilities and insurance/TPA operations, including claims administration, workflows, regulatory considerations, data privacy, and the importance of human oversight in claims decisions. 

Preferred: 

• Experience in workers’ compensation, liability, property & casualty, disability, or other insurance-related operations.
• Experience working for or with a third-party administrator (TPA).
• Experience with claims systems and insurance data.
• Knowledge of data governance, privacy, information security, and AI risk management.
• Experience with process-improvement methodologies such as Lean, Six Sigma, or Kaizen. 

Computer Skills    

• Experience with Power BI, SQL, Excel, Power Automate, or similar analytical/automation tools.
• Experience developing AI prompts, workflows, or AI-assisted applications.
• Proficient in Microsoft Office products.

 Preferred Certifications

• Lean Six Sigma Green Belt or Black Belt
• Microsoft Copilot Certification
• Microsoft Power Platform Certification
• AI-related professional certification 

Key Performance Indicators 

Success in this position may be measured by:

• Number and quality of AI opportunities identified and successfully implemented.
• Productivity/time savings generated by AI initiatives.
• Reduction in manual or repetitive processes.
• Improvement in claims or operational cycle time.
• Quality and accuracy improvements.
• Employee adoption and utilization of approved AI solutions.
• Cost savings or cost avoidance.
• Successful completion of AI projects.
• User and stakeholder satisfaction.
• Compliance with AI governance and security requirements.