Claim Operations Specialist - Centennial, CO

Military Spouse Corporate Career Network•Centennial, CO

About The Position

Under moderate supervision, the Claim Operations Specialist partners with claim professionals to assist customers and support timely claim resolution. The role builds customer relationships, completes financial transactions, updates and manages business information, and handles related duties and projects. This position does not manage others. The position supports claim operations through customer service, claim documentation and file handling, payment and expense processing, data and information management, and financial controls. It may require occasionally lifting items up to 20 pounds.

Requirements

High school diploma or GED.
At least 1 year of service-related work experience, or a bachelor's degree.
Experience utilizing computer technology such as Microsoft Office, email, web-enabled applications, and database software.
Verbal and written communication skills.
Ability to analyze and compare information to understand issues and explore alternative solutions.
Ability to exercise sound judgment and make decisions.
Ability to seek out, build, foster, and maintain productive working relationships.

Nice To Haves

Accountability and ownership of actions, outcomes, performance, and results.
Ability to remain energized and focused amid ambiguity, change, or strenuous demands.

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 or 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 using appropriate technology; update data discrepancies; and use management information to prepare line-of-business or financial reports.
Prepare operational reports for claim professionals and managers, and accurately document pending and completed work activities in appropriate systems.
Perform underlying claim-center financial controls, communicate findings, assess data reasonableness, identify discrepancies, conduct reconciliations, and assess the effectiveness of financial controls.
Prepare data entries in accordance with established standards.
Perform other duties as assigned.