Claims Operations Specialist - HYBRID

DB Insurance Co., Ltd. • Village of Great Neck Plaza, NY

1d • $70,000 - $100,000 • Hybrid

About The Position

DB Insurance is seeking an experienced, self-starting individual to join our team as a Claims Operations Specialist. As part of our Strategy / Planning team, you will work with various departmental and team leaders to ensure all aspects of our operations fall within both applicable regulatory standards and industry best practices. Your responsibilities and preferred credentials are outlined below.

Requirements

• 5–7+ years of progressive experience in property and casualty (P&C) claims, with deep industry knowledge and understanding
• Proven experience in a claims auditing, quality assurance, or compliance-focused role, including experience managing or auditing
• Strong knowledge of state and federal insurance regulations, Fair Claims Settlement Practices, and compliance requirements (including Medicare Secondary Payer/Section 111 Reporting)
• Knowledge of operational setup and compliance required for expansion into new jurisdictions
• Demonstrated ability to proactively investigate root causes of errors and propose strategic solutions for quality improvement
• Proficiency in financial data analysis
• Experience collaborating with IT teams and external vendors on system development, maintenance, or process improvement
• Strong written and verbal communication, organization skills, critical thinking, and analytical capabilities
• Bachelor’s degree in Business, Finance, Computer Science, Statistics, or a related field is preferred

Nice To Haves

• Proficiency in SAP, Power BI, SQL, Python, R, Tableau, Excel, and/or data cleaning is preferred
• Professional insurance designations (e.g., CPCU, AIC) are highly desirable
• Certification from the International Compliance Association or another recognized compliance group is a plus
• Bilingual in Korean is a plus

Responsibilities

• Manage and conduct pre- and post-payment adjudication audits on claim matters to ensure financial, processing, and operational accuracy
• Verify that claim adjudication aligns with policy terms, standard operating procedures (SOPs), and state or federal regulations.
• Investigate the underlying causes of errors, overpayments, or underpayments to prevent future recurrence
• Conduct reviews of existing policies, SOPs, and guidelines to ensure relevance, accuracy, and compliance with current laws and industry standards
• Proactively propose updates to policies, SOPs, and guidelines based on audit findings and changing legal requirements
• Handle claims operational setup and compliance frameworks required for business expansion into new states
• Assess claim departmental workflows and results to assist with the development of key performance indicators (KPIs) and evaluation metrics
• Support month-end closings and provide statistical data analysis
• Participate in, with the potential to oversee, system development, maintenance, and support, while collaborating with and managing external vendors
• Ad-hoc projects and other responsibilities as assigned

Benefits

• Medical (PPO), dental (PPO), vision (PPO), and life insurance covered 100% by the company and 50% for dependents
• Paid time off and sick leave
• 13 annual paid holidays
• 401(k) plan with up to 4% company match
• Flexible Spending Account (FSA) & Dependent Care FSA
• Quarterly Fringe Benefit reimbursements
• Job-related training reimbursement
• Casual dress code

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level