Claims Operations Specialist
New
C
Coalition, Inc.Insurance
Any location, United StatesFull-TimeMiddle
Salary75,000 - 100,000 USD per year
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Job Details
- Experience
- 4+ years
- Required Skills
- Data AnalysisSalesforceMicrosoft ExcelRisk ManagementProcess improvementData management
Requirements
- 4+ years of experience in insurance claims operations, ideally within a high-growth, dynamic environment.
- Excellent data analysis and systems savvy
- Understanding of insurance concepts
- Customer service, creative problem solving mindset
- Advanced Excel and data management skills, with experience handling large datasets
- Experience as a heavy contributor or leader of a cross functional product/process
- Superior written and verbal communication skills
Responsibilities
- Own the overall operational process for the production and transmission of accurate, complete, and timely claims bordereaux for carrier partners.
- Elevate claims data into a reliable, decision-driving asset for Finance, Actuarial, and leadership by improving data standards, completeness, and consistency.
- Serve as the operational point of contact for carrier partner BDX inquiries—coordinating responses, root-cause analysis, corrections, and preventive process improvements.
- Drive continuous improvement in data quality and reporting consistency that strengthens trust with carrier partners.
- Oversee claims payment enablement, including invoice processing, reconciliations, and related controls to ensure accuracy, timeliness, and compliance with carrier and regulatory requirements.
- Partner with technology teams to explore and implement Gen-AI and advanced analytics use cases that improve productivity, insight generation, and customer experience.
- Build and maintain operational controls and monitoring to support internal claims audits, carrier partner reviews, and compliance assessments.
- Maintain audit-ready processes, documentation, and evidence to support internal and external reviews.
- Collaborate closely with Claims, Actuarial, Data, Product, and Engineering on strategic initiatives and operational roadmaps.
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