Claims Operations Analyst

Canopius•Chicago, IL

2d•$60,000 - $75,000

About The Position

The Claims Operations Analyst will provide oversight, technical, and administrative support to the claims team in a professional, timely, and fair manner, ensuring excellent customer service to both internal and external customers. This role involves overseeing and providing technical support, quality oversight, and governance of offshore partners. The analyst will act in accordance with, drive, and further the aims set out in the claims promise: to push the boundaries of customer service excellence through an empowered, collaborative, and innovative approach to claims that makes the company the envy of the market.

Requirements

Business Intelligence
Communication
Customer Relationship Management
Data Analysis
Escalation Management
Internal Controls
Operational Claims Management
Process Management
Quality Assurance
Regulatory Compliance
Third-Party Management

Responsibilities

Ensure effective oversight of service providers or outsource partners, flagging any issues of concern and proposing remediation plans.
Manage the onboarding of new Delegated Claims Administrators (DCAs) in collaboration with Group Claims Operations and various functional stakeholders.
Administer DCA contracts.
Co-manage first notice of loss and reports of loss to excess carrier with the Claims Assistant.
Set up new claims in Origami Risk and assign to the appropriate adjuster for open market Cyber claims.
Refer notice of loss to the appropriate Third-Party Administrator (TPA)/claim handler for all other programs.
Coordinate and assist with the resolution of claims bordereaux data quality issues in collaboration with the US Region Data Operations team and/or Group Claims.
Represent Claims Operations in data governance forums, ensuring data quality standards are met and supported by appropriate controls.
Monitor data integrity across operational processes and escalate discrepancies.
Monitor and enhance controls, ensuring they are working effectively, and report failures with proposed remediation plans.
Continually review and update all claims SOPs to ensure processes are optimal and followed.
Support the US Claims team in proactively managing and addressing ad hoc queries or requirements from stakeholders.
Oversee the internal claims peer review process to ensure the annual plan is met and performance issues are raised, including providing monthly status reports.
Make proactive and meaningful contributions to project and transformational work per the team’s strategic priorities.
Work with the Claims Operations team to manage fiscal controls required to support the claims function.
Maintain and enhance operational processes that support the claims lifecycle, ensuring accuracy, timeliness, and compliance.
Coordinate and oversee annual DCA audits and support adjusters in their review of claims files.
Act as the liaison contact for internal/external auditors.
Coordinate the setup of new loss funds for new/existing DCAs.
Oversee the administration of existing loss funds, including increases, monthly replenishment/top-ups, and cash calls.
Ensure loss fund reconciliation documents are received from DCAs in line with reporting requirements and SLAs.
Liaise with Finance regarding loss fund reconciliations and ensure appropriate funds are held in the FCP account.
Act as a loss fund referral point for TPAs/brokers and other external stakeholders.
Perform loss fund reconciliation monthly.
Manage the end-to-end loss fund process (legacy, current, and future FCP), ensuring they are maintained in accordance with policy and procedures, and obtain full details of potential issues before deciding on resolution.