Claims Operations Service Specialist

AAA • Lincoln, RI

5d • Onsite

About The Position

The Claims Operations Service Specialist performs duties in support of the Claims business unit goals and objectives, as well as develops processes to increase the effectiveness of the operations. This involves duties that ensure compliance with government regulations and banking accuracy. In addition, this position produces statistical reports along with technical assistance in identifying systems issues. When systems issues have been identified, participates in testing business and functional processes along with recommendations for solutions to the identified issue. Work is performed under general supervision. Work is reviewed for sound judgment and the proper application of concepts, and principles. Work requires knowledge of best practices, methods, and concepts in claims operations. Develops solutions to a variety of problems.

Requirements

• Bachelors' OR Equivalent combination of education and experience
• Intermediate to advanced PC skills required.
• Microsoft Office: Excel, Word, Access, Publisher and PowerPoint
• Effective organization and planning skills required.
• Effective oral and written communication skills required.
• Good interpersonal skills required.
• Basic analytical skills

Nice To Haves

• 1-7 years of experience in Operations/Hardware preferred.
• Familiarity with Club software programs preferred (Claims Portal, Business Objects, CACS, PRIME, HUON, etc.).

Responsibilities

• Quality review of new vendor set up (tracking of required forms and fields) for correctness and completeness to generate payments.
• Process levies against vendors and child support liens.
• Track over payments reimbursement from vendors.
• Claims accounting for overpayments.
• Research unidentified recoveries.
• Produces moderately complex reports regarding claims data to determine performance trends.
• Reports data to regulatory agencies.
• Develop functional expertise with reporting solutions.
• Works with Insurance Accounting, Corporate Banking and Finance to reconcile and post money recoveries to identify discrepancies.
• Reconcile banks statements.
• Process annual 1099 for claims vendors and resolve disputes.
• Complete payment corrections.
• Process unclaimed claims payments to the appropriate state governmental agency.
• Vendor EFT set up.
• Investigates systems issues reported by staff to determine if it is a systems issue or user error.
• Resolve claims related IM tickets from Help Desk.
• Develop and update systems requirements.
• Ensures accuracy and appropriateness of basic user profile data for claim systems and support applications.
• Participates in internal/external financial and systems audit.
• Follow up on corporate assets that are assigned to claims operating unit.
• Functional knowledge and expertise on internal and external claims applications.
• Liaison with other business units on matters concerning Finance, Underwriting, Corporate Cashiering, Purchasing, PMG, and Security Administration.
• Special projects to support department and corporate goals.
• Assist in developing the most appropriate processing alternative to meet user workflow, regulatory best practices, and system requirements.
• Help determine if exceptions are a result of a system program, equipment or user error.
• Aid in determining how to best resolve exceptions.

Benefits

• Health coverage for medical, dental, vision
• 401(K) saving plans with company match AND Pension
• Tuition assistance
• Floating holidays and PTO for community volunteer programs
• Paid parental leave
• Wellness programs
• Employee discounts (membership, insurance, travel, entertainment, services and more!)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree