Claim Operations Specialist - Centennial, CO
About The Position
Under moderate supervision, the Claim Operations Specialist partners with claim professionals to assist customers. The role includes building customer relationships, completing financial transactions, updating and managing business information, and handling other duties and projects. This position does not manage others. The specialist supports customer service and claim operations, processes claim payments and expenses, maintains accurate data and records, and assists with financial controls and assessments. The position may require occasionally lifting items up to 20 pounds and includes other duties as assigned.
Requirements
- High school diploma or GED.
- One year of service-related work experience, or a bachelor's degree.
- May require occasionally lifting items up to 20 pounds.
Nice To Haves
- Experience using computer technology such as Microsoft Office, email, web-enabled applications, and database software.
- Accountability and ownership of actions, outcomes, performance, and results.
- Analytical thinking, including the ability to analyze and compare information and explore alternative solutions.
- Ability to remain energized and focused amid ambiguity, change, or strenuous demands.
- Verbal and written communication skills.
- Sound judgment and decision-making ability.
- Ability to build and maintain productive working relationships.
Responsibilities
- Promptly and professionally address customer questions and concerns, triage and route callers, and answer claim status and payment questions.
- Partner with claim professionals across departments to support timely claim resolution.
- Document claim files, including notes and diaries; request reports and records; and review medical bills, mail, and wage statements.
- Print and prepare claim documents for legal and medical reviews; report and assign claims; and transition closed files to and from off-site storage.
- Receive, sort, scan, and upload incoming mail; process outgoing mail; and order, receive, and distribute supplies and equipment.
- Process and issue claim payments, including outside vendor invoices, attorney expenses, and medical processing fees.
- Process and document returned checks, voided checks, and credits, ensuring check processing is timely and accurate.
- Prepare, generate, and review reports; update data discrepancies; use management information to prepare line-of-business or financial reports; and accurately document pending and completed work activities.
- Assist with claim center financial standards by performing controls, communicating findings, assessing data reasonableness and discrepancies, completing reconciliations, assessing financial controls, and preparing data entries in accordance with established standards.
- Perform other duties as assigned.
Benefits
- Eligible for performance-based cash incentive awards as part of the compensation and benefits program.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
