Claims Operations Specialist

As a Claims Operations Specialist, you will support the end-to-end claims intake process by managing intake channels, claim set up, and responsive assistance. Your role will include combining advanced administrative expertise with operation support for the claims team. You will work closely with the Claims Care phone team and claims examiners to support ongoing processes and knowledgeable backup. This is a hybrid position that assists with mail claims processing and provides support to the Claims Care phone team during periods of high volumes or as assigned.

Your responsibilities will include:

• Establish new claims in the existing claims system from all incoming sources, determines required documentation and initiates corresponds to obtain missing requirements.
• Processes web claims submissions across platform including set up, required determination, communication, and processing payments following.
• Monitors and triages incoming claims emails and queues, ensuring timely routing, response, and follow-up.
• Matches incoming claims requirements to pending claims, documents receipts, and prepares claim files.
• Previews death claims, follow-up with funeral homes regarding any outstanding requirements or uncashed drafts.
• Resolve routine inquiries and escalate complex issues as needed.
• Maintains organized and compliant claims files, ensuring all documents meet standards.
• Provides additional support to Claims department and Claims Care Phone team calls as needed during periods of high volume.