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As a Payer and Adjudication Subject Matter Expert, you will generate test claims to evaluate agentic AI solutions, supporting internal functions and governance. You'll create files simulating Payer Operations AI, identify and construct claim scenarios, and translate product requirements into scalable testing files. This includes determining claim outcomes, calculating financial impacts, and ensuring traceability of logic. Additionally, you will create structured outputs (X12, JSON, Excel) for agent testing and QA, and support model testing, agent evaluation cycles, and AI governance reviews.

We seek a seasoned professional with over 11 years in the software industry or a related field, including 5+ years in product management, claims operations, or payer testing/QA. Candidates should possess direct experience with operational challenges like denials and configuration complexity, coupled with hands-on experience in AI/ML products. Solid payer domain knowledge covering claims, benefits, and prior authorization is essential. A proven ability to manually apply adjudication rules and comfort with structured data formats (X12, JSON) and QA processes are required.