Corporate Risk and Claims Specialist

Jackson Healthcare • Alpharetta, GA

2d • Hybrid

About The Position

The Corporate Risk and Claims Specialist is an Individual Contributor responsible for the daily execution of provider Risk Reviews, malpractice Claims Verification, and Claim administration across the Jackson Healthcare family of companies. Jackson Healthcare's core business is placing physicians, nurses, and other healthcare providers in clinical settings across the United States on a short-term basis; each of the 22 Jackson companies sources and credentials these providers through a rigorous screening process. This role is the engine of that process, evaluating escalated provider files, confirming loss-history and claims exceptions, and coordinating state-level PCF enrollments, all while applying sound judgment, process discipline, and meticulous attention to detail. The Corporate Risk and Claims Specialist partners closely with company representatives, an external enrollment vendor, and insurance entities to ensure timely, accurate, and audit-ready outcomes.

Requirements

• Bachelor's degree in Risk Management, Finance, Business Administration, or a related field required; equivalent combination of education and experience considered.
• 3 - 5 years of progressive experience in claims administration, insurance operations, or a related field required.
• Experience with claims management systems and quality assurance processes required.
• Demonstrated knowledge of property, casualty, or workers compensation claims processing required.
• Strong organizational skills and ability to manage a claims workload independently.

Nice To Haves

• Associate in Claims (AIC) designation preferred.
• Experience with quality assurance or audit processes in an insurance or risk environment preferred.
• Knowledge of regulatory requirements applicable to claims handling preferred.

Responsibilities

• Manage end-to-end claims intake and processing, including claim logging, coverage verification, adjuster assignment, and documentation collection.
• Evaluate claim submissions for coverage applicability, completeness, and compliance with policy requirements; escalate complex coverage questions appropriately.
• Monitor open claims for timely resolution; coordinate with adjusters, carriers, and internal stakeholders to advance claim progress.
• Maintain accurate claims records in the claims management system; ensure data integrity and timely updates.
• Conduct quality reviews of claims files to verify accuracy, completeness, and compliance with internal standards and regulatory requirements.
• Apply quality scoring frameworks to evaluate adjuster performance and claims handling outcomes; summarize findings for supervisor review.
• Support internal audit processes by preparing claims file samples, organizing documentation, and tracking audit findings.
• Recommend process improvements based on quality review observations and recurring deficiency patterns.
• Serve as a point of contact for claimants, internal departments, adjusters, and carriers on routine claims matters.
• Communicate claim status, coverage determinations, and resolution timelines clearly and professionally.
• Coordinate documentation exchanges between internal and external parties to support timely claims resolution.
• Prepare claims status summaries and correspondence as required by the claims team or business partners.
• Identify gaps in claims processes and recommend workflow improvements to the Senior Corporate Risk and Claims Specialist
• Produce routine claims reports including volume, cycle time, open claim aging, and quality metrics.
• Support special projects and ad hoc analyses as assigned by senior team members.

Benefits

• We are an Equal Opportunity Employer and do not discriminate based on race, color, religion, sex, national origin, age, disability, veteran status, or any other protected status under the law.

What This Job Offers

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