Claims Clerk

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Company Description

Scry AI is a research-led enterprise AI company that builds intelligent platforms to drive efficiency, insight, and compliance. Our platforms Collatio®, Auriga®, and Concentio® help insurers and TPAs automate document intake, validation, reconciliation and deliver real-time intelligence.

Role Overview

As a Claims Clerk (SME), you’ll be the go-to expert for end-to-end claims administration, standardizing intake, verification, and adjudication preparation while improving accuracy, turnaround time, and audit readiness. You’ll translate domain rules into clear SOPs, tagging schemas, and validation checklists that power Scry AI products (Collatio® for document intelligence and Auriga® for knowledge assistance), and you’ll coach the team on best practices.

Key Responsibilities

Operational Excellence & Governance

• Own SOPs, checklists, and quality gates for claims intake, validation, and file preparation.

• Define and maintain rules libraries (coverage, eligibility, deductibles, exclusions) and calculators.

• Run QC audits, measure TAT/accuracy, and drive corrective actions and RCA/postmortems.

Claims Processing (SME Hands-On)

• Review submissions; verify policyholder/provider data, coverage terms, and completeness.

• Extract and validate structured fields (dates, amounts, codes); reconcile discrepancies.

• Prepare adjudication-ready files; raise RFIs and track responses to closure.

AI/Automation Enablement

• Partner with product/data teams to design field taxonomies, label policies, and validation rules.

• Use Collatio® to auto-capture claim fields, BOM-like itemizations, and EOB details; validate outputs.

• Curate ground-truth datasets and feedback loops to reduce extraction errors and false positives.

Compliance, Audit & Fraud Vigilance

• Ensure documentation meets regulatory/privacy standards (IRDAI; HIPAA/GDPR as applicable).

• Maintain audit trails, revision histories, and communication records.

• Identify fraud/abuse indicators; escalate and document investigative notes.

Knowledge & Training

• Create playbooks, macros/templates, and FAQ articles for Auriga® knowledge base.

• Deliver training, shadowing, and certification paths for clerks/new hires.

• Act as SME on customer calls, RFIs, and process transition/wrap-up meetings.

Required Qualifications & Skills

• 2+ years in claims operations (health, motor, property) at an insurer/TPA/BPO.

• Strong command of policy terms, EOBs; health lines: familiarity with CPT/ICD codes.

• Proven record meeting TAT/accuracy targets; expert in documentation and QC.

• Proficiency with spreadsheets, PDFs, claims/CRM systems; comfort with high-volume queues.

• Excellent written/verbal communication; ability to convert domain rules into clear SOPs.

Nice to Have

• Experience with AI/IDP tools (e.g., Collatio®) and rule-based adjudication engines.

• Exposure to fraud frameworks and evidence handling.

• Process improvement certifications (Lean, Six Sigma Yellow/Green Belt).

Our Ideal Candidate

• Treats every claim as data: structured, validated, and audit-ready.

• Uplifts teams through standards, training, and measurable quality improvements.

• Comfortable collaborating with product/data engineers to make automation stick.

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