Health Insurance Subject Matter Expert (Fully Remote)

What You’ll Do

We are seeking a highly experienced Health Insurance Subject Matter Expert (SME) who has lived and breathed insurance operations and is ready to help transform the industry through technology . They think in systems, challenge the status quo, and are excited to translate years of operational expertise into intelligent product features, automation logic, and scalable workflows .

This person brings deep health insurance domain knowledge and the drive to change the industry. This is a hands‑on, embedded role working closely with CoverGo's product and engineering teams to ensure what is built is accurate, compliant, and truly reflects how health insurance works in the real world.

1. Domain Expertise & Product Collaboration

• Support the product team throughout the feature development lifecycle with deep health insurance expertise and operational insight.
• Translate end‑to‑end health insurance processes — underwriting, policy administration, claims, renewals, billing — into clear product requirements and functional documentation.
• Validate and define business rules, decision engines, and workflow logic to ensure all outputs are accurate, compliant, and usable in real‑world scenarios.
• Participate actively in User Acceptance Testing (UAT) to validate functionality, workflows, and business logic.

2. STP, Automation & Workflow Design

• Design for maximum Straight‑Through Processing (STP) across product flows — minimising manual intervention through intelligent system design.
• Define automation rules, decisioning frameworks, and exception handling flows that reflect real‑world insurance operations.
• Ensure the product accurately reflects how the business operates, embedding efficiency and scalability directly into the system.

3. Compliance & Risk Embedded in Product

• Translate regulatory and policy requirements into system logic and product features.
• Conduct market and competitor research to identify feature gaps, best practices, and emerging trends in global health insurance.

4. Cross‑Functional Collaboration & Enablement

• Act as the bridge between Product, Engineering, and Business teams — translating business needs into product requirements into technical execution.
• Contribute to product roadmap discussions and prioritisation from a health insurance perspective.
• Engage with internal and external stakeholders, including clients, partners, and insurers, to gather feedback and validate product direction.
• Support GTM, sales, and pre‑sales efforts with deep functional expertise when needed.

What We Need

• 12+ years of experience in the insurance industry , with strong exposure to end‑to‑end insurance operations.
• At least 5 years of hands‑on experience in health insurance with deep understanding of the full health insurance lifecycle, with domain expertise inside and out.
• Experience across 2 or more health insurance functions: product setup, underwriting, pricing, policy administration, endorsements, billing, claims, or renewals.
• Experience working cross‑functionally with product, technology, and business teams in a fast‑paced environment.
• Hands‑on, results‑oriented, and passionate about translating domain knowledge into real product features.
• Systems thinker with a natural ability to understand how processes connect, where automation can replace manual work, and how rules translate into logic.
• Critical, analytical, forward‑thinking, and innovative — able to identify gaps others miss and propose solutions, not just observations.
• Strong verbal and written communication skills — able to explain complex insurance concepts to technical and non‑technical audiences alike.
• Demonstrated client‑facing capability to handle clients and stakeholders confidently, even without formal sales experience.

Nice‑to‑have (other advantages)

• Experience with other lines of business such as life and/or P&C insurance.
• Chartered Insurance Institute (CII) Certificate in Insurance or equivalent.
• Technology‑savvy — worked on digital transformation initiatives or has exposure to insurance systems. Insurtech experience as SME/Consultant is a strong plus.
• Exposure to multiple markets or global health insurance products.

Why You’ll Love Working Here

• Fully Remote
• Flexible Leave
• International Environment
• Competitive renumeration package
• Performance Bonus
• Company activities and events
• Learning and development plan
• Remote work allowance

#J-18808-Ljbffr