Risk & Claims Operations Specialist
Core
Manage daily intake and completion of provider Risk Reviews, verify medical malpractice claims, and coordinate Patient Compensation Fund enrollments across 22 healthcare companies.
Role type
Risk & Claims Operations Specialist
Builds
Risk review processes, claims verification workflows, and patient compensation fund enrollment coordination
Domain
Healthcare operations and risk management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Advanced Excel, process discipline, cross-functional collaboration, data integrity management, stakeholder communication, audit readiness, workflow optimization, Microsoft Teams/SharePoint proficiency, report preparation
Preferred skills
Experience in Risk Management, Healthcare Operations, or Credentialing, process improvement background, matrixed environment experience
Technologies
Microsoft Excel, Microsoft Teams, SharePoint, VComm, MDStaff, Outlook, Origami, PowerPoint
Responsibilities
Manage daily intake and completion of provider Risk Reviews, evaluate escalated provider files using preestablished guidelines, investigate documentation against defined standards, prepare summary reports documenting findings, assign approval levels to provider files, record Risk Review outcomes in Origami, monitor exception queues for claims verification, coordinate Patient Compensation Fund enrollments across five states, prepare monthly PowerPoint presentations for leadership, build and maintain Excel-based tracking tools
Seniority
Mid-level, hands-on IC