Operations Specialist
Core
Client-facing operations specialist supporting claims administration, acting as a liaison between carriers, underwriters, and claim handlers to ensure accurate data exchange and program compliance.
Role type
Operations Specialist (Claims Administration)
Builds
Claims data accuracy, program guideline adherence, and operational efficiency for insurance carriers.
Domain
Insurance / Claims Administration
Deliverable
dashboards & analysis
Required skills
Claims administration, carrier communications, data management, program guideline maintenance, reporting, quality assurance, document management, insurance terminology, claims processes, organizational skills, attention to detail, Microsoft Office proficiency, claims management systems.
Preferred skills
Delegated authority experience, TPA/MGA/Carrier program experience, bordereau reporting, KPI monitoring, specialty insurance programs, transportation/environmental claims.
Responsibilities
Serve as primary operational contact for carriers and stakeholders; coordinate with underwriting teams for risk codes and policy info; review and enter new claims data into management systems; maintain program guidelines and workflows; monitor KPIs and bordereau reporting; support audits, file reviews, and data validation; provide Medicare compliance and OFAC checks; act as file closer for settled claims.
Seniority
Individual Contributor