AI Decision Support Specialist

2 weeks ago

Rolling Meadows, United States Gallagher Full time
Introduction:

Join our growing team of dedicated professionals at Gallagher Bassett, who guide those in need to the best possible outcomes for their health and wellbeing. You'll be part of a resilient team that works together to redefine the boundaries of excellence. At our organization, we value collaboration and making a positive impact in the lives of our clients and claimants, offering you the opportunity to join a team where your skills and dedication can truly make a difference. GUIDE. GUARD. GO BEYOND.

We believe that every candidate brings something special to the table, including you So, even if you feel that youre close but not an exact match, we encourage you to apply.

How you'll make an impact:
  • The AI Decision Support Specialist role will be responsible for reviewing claims identified by our decision support predictive models. The specialist will analyze model alerts and claims identified as having common claim characteristics that may indicate certain risks.
  • If the risk exists, the specialist will review the claim file to determine the best intervention strategy for a claim to the Resolution Manager in order to mitigate the risk identified.
  • Hand keyed recommendations are presented to our Resolution Managers, as decision support, including a brief summary of why the resource is needed, what benefit the resource can offer and provide information to the Resolution Manager to use when discussing the potential mitigation plan with the client.

Essential responsibilities include:

  • Generating meaningful recommendations for GBs Claims Operations by combining claims expertise with the GBs AI-enabled decision-support products.
  • Exercising proper judgment and decision making to analyze the claims exposure to determine the most appropriate intervention strategy at the proper interval, moving the claim towards effective resolution, consistent with client and corporate policies, GB best practices and standard operating procedures, as well as in accordance with any statutory, regulatory and ethics requirements.
  • Documenting and communicating clear and concise, prescriptive recommendations to claims teams, when specified intervention strategies may help drive superior claim outcomes.
  • Ability to work at full case load capacity, managing daily assignments efficiently and effectively with excellent prioritization and organizational skills.
  • Communicating in a professional, positive and proactive manner.
  • Using metric-driven reporting tools to evaluate performance and identify problem areas in advance of them becoming service issues.
  • Working collaboratively across internal departments including Claims Operations, Client Services, and Product/Analytics to drive effective application of decision support products.
About you:
  • High school diploma
  • 2 years claims related experience required.
  • Knowledge of accepted industry standards and practices.
  • Computer experience with related claims and business software.

Preferred Requirements

  • Bachelors degree
  • 3 or more years of claims handling experience
  • Experience handling multiple jurisdictions, multi-level complexity of claims and preferably multiple lines of insurance
  • Wide variety of industry experience and/or broad knowledge of healthcare, data analytics, data science or machine learning.

Work Traits:

  • Ability to think critically and solve problems in order to make decisions and resolve issues inherent in handling of claims
  • Understand claim concepts: liability, mechanism of injury, nature and extent, medical terminology and familiarity with litigation
  • Communicate effectively and exchange information clearly and concisely
  • Demonstrate superior written and interpersonal communication
  • Perform work independently, work as part of a team and follow directions
  • Work in a fast paced environment and have great time management skills
    • Interact with others within other levels of the organization, to build alignment and reach target goals

  • Working Conditions:

    • Work is flexibly performed remotely
    • Perform with minimum supervision and exercise sufficient discretion and independent judgment
    • Adhere to Standard Operating Procedures and GB Best Practices
    • Conserve confidentiality of company research and work efforts


Compensation and benefits:

On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.

Below are the minimum core benefits youll get, depending on your job level these benefits may improve:

  • Medical/dental/vision plans, which start from day one
  • Life and accident insurance
  • 401(K) and Roth options
  • Tax-advantaged accounts (HSA, FSA)
  • Educational expense reimbursement
  • Paid parental leave

Other benefits include:

  • Digital mental health services (Talkspace)
  • Flexible work hours (availability varies by office and job function)
  • Training programs
  • Gallagher Thrive program elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
  • Charitable matching gift program
  • And more...

We value inclusion and diversity

Click Here to review our U.S. Eligibility Requirements

Inclusion and diversity (I&D) is a core part of our business, and its embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.

Gallagher embraces our employees diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.

Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as protected characteristics) by applicable federal, state, or local laws.

Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.

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