Insurance Operations Specialist

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Receive and assess notifications of incidents, claims, demands, lawsuits, administrative charges, and other matters that may be covered by insurance.

• Collect incident reports, supporting documents, correspondence, and relevant information to create comprehensive claim files.

• Input new claims and update existing claim data in the claims management and internal tracking systems.

• Ensure timely reporting and submission to carriers, third-party administrators, and brokers, while escalating issues as necessary.

• Keep organized claim files and retain documentation throughout the lifecycle of each matter.

• Monitor open claims, significant dates, follow-ups, mediations, hearings, settlement payment dates, reporting deadlines, and other key milestones.

• Follow up on open claims and outstanding requests, escalating unresolved issues or those needing management attention.

• Review open claims for outdated matters, incomplete records, missing updates, unresolved action items, and potential closures.

• Communicate with carriers, third-party administrators, brokers, adjusters, and external legal counsel regarding claim management.

• Collaborate with facility leadership and internal departments to obtain necessary medical records, personnel information, and incident documentation.

• Track information and documentation requests until completion or escalation.

• Identify matters that need further review and inform Legal or Company leadership of significant developments, delays, or unresolved issues.

• Monitor processes related to service of process, attorney correspondence, administrative filings, mediations, settlements, and other important claim events.

• Maintain records of claim status, reserves, legal expenditures, settlements, and final outcomes.

• Confirm closure of claims and preserve complete final claim records.

• Prepare claim summaries, litigation reports, insurance reports, and other claim-related documentation.

• Assist with insurance and claims information requests for audits, due diligence, transactions, renewals, and organizational initiatives.

• Reconcile and verify claim information across internal systems, carrier and third-party administrator reports, and other documentation.

• Suggest enhancements to claim intake, tracking, documentation, and follow-up processes.

• Collaborate with Legal, Human Resources, facility leadership, Finance, and other corporate departments.

• Uphold the confidentiality of sensitive claim, employee, patient, legal, and business information.

• Perform additional duties as assigned.

⛳️ Requirements

• A high school diploma or equivalent is required.

• Relevant professional experience may be considered in lieu of formal education.

• A minimum of 3 years of experience in claims administration, insurance operations, workers’ compensation administration, insured litigation support, or a related field is required.

• Experience in communicating and coordinating with insurance carriers, third-party administrators, brokers, claims adjusters, and/or external legal counsel is strongly preferred.

• Experience with commercial insurance claims is preferred.

• Background in healthcare, behavioral health, or multi-state claims is advantageous.

• Familiarity with a claims management system, RMIS, matter management system, or similar tracking platform is preferred.

• Strong proficiency in Microsoft Office and/or Google Workspace.

• Ability to maintain accurate trackers, reports, electronic files, and claim documentation.

• Exceptional organizational skills and attention to detail.

• Capability to manage a high volume of claims, deadlines, follow-ups, and competing priorities.

• Initiative and ability to follow through on pending matters.

• Ability to work with minimal supervision in a high-volume environment.

• Discretion and sound judgment with sensitive, confidential, and potentially privileged information.

• Strong problem-solving abilities.

• Ability to review and comprehend claim-related documents, including incident reports, demand letters, legal correspondence, lawsuits, administrative filings, insurance information, and settlement documentation.

• Clear and professional communication with internal stakeholders and external insurance and legal partners.

• Ability to maintain accurate and complete records.

• Capability to work collaboratively across Legal, Human Resources, Finance, and other functional areas.

• Prolonged sitting at a desk is required.

• Must be able to lift up to 15 pounds at a time.

🏝️ Benefits

• Work/life balance.

• Investment in education.

• Company-matching 401K.

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Life insurance.

• Equal opportunity employment.

• Reasonable accommodations for disabilities.