Health Insurance Expert

Role Overview

Mercor is partnering with leading AI labs to engage experienced health insurance professionals — benefits administrators, underwriters, claims managers, actuaries, and compliance specialists — to improve AI systems' reasoning around coverage determination, utilization management, and plan design. Contributors will apply their expertise in areas such as commercial group and individual plans, government programs (Medicare, Medicaid, ACA marketplace), prior authorization workflows, and insurance regulation to evaluate and enhance AI performance on health insurance-specific tasks. This is a project-based opportunity with potential for ongoing engagement depending on performance and project needs.

Key Responsibilities

• Review and evaluate AI-generated outputs related to plan benefit design, coverage determination, claims adjudication, and medical necessity criteria
• Create realistic scenarios based on health insurance workflows — prior authorization decisions, explanation of benefits reviews, formulary exceptions, network adequacy assessments, and regulatory audits
• Annotate, label, and validate data across health insurance use cases (e.g., ICD coding accuracy, payer policy interpretation, managed care utilization review)
• Provide structured feedback on AI accuracy in areas such as federal and state insurance regulations (ACA, ERISA, HIPAA, CMS guidelines), payer contracting, and industry-specific terminology
• Collaborate asynchronously with research teams to refine evaluation frameworks for health insurance AI

Ideal Qualifications

• 3+ years of professional experience at a health plan, benefits administrator, TPA, PBM, or managed care organization
• Background in one or more areas such as:
  • Claims processing and adjudication (medical, dental, pharmacy)
  • Medical underwriting or actuarial analysis for health plans
  • Utilization management or care management (UM/CM)
  • Benefits administration (group, individual, Medicare Advantage, Medicaid managed care)
  • Regulatory compliance, product development, or government programs (ACA, Part D, CHIP)
• Professional designations a plus (CEBS, AHIP, HIAA, Fellow/ASA actuarial credentials)
• Strong analytical thinking and ability to translate health plan workflows into structured evaluation tasks
• Clear written communication and attention to detail

Compensation Note

• Task Completion Pay: Competitive and based on task quality (~$900 – $1,250 per completed task, subject to change as the project evolves)
• Performance Bonus: Top performers receive a weekly bonus incentive on top of their per task rate!
• Hourly Opportunity: Top performers may be invited to transition to an hourly compensation model based on sustained quality and throughput.