Senior Claims Operations Analyst

at Crawford & Company in Lake Zurich, Illinois, United States

Job Description

Senior Claims Operations Analyst

Requisition ID 
2024-25152  

 Job Locations  
US-IL-Lake Zurich  

Position Type 
Regular Full-Time  

Category 
Finance & Accounting  

Business Unit 
BUS_TPA US
Excellence In Everything We Touch

Position Summary

Under the general direction of the Claims Data Operations Manager, the Senior Claims Analyst provides a variety of critical operational support services to the Claim Department, its business partners and its clients related to the handling of returned checks, processing of refunds, escheatment review, paying of invoices and fees, and analysis of Control request.

Responsibilities

Provides subject matter expertise on various complex projects that are assigned to Business Support Services for handling to completion i.e., Take Overs, Reverse Take Overs, Novations/Buybacks, Carrier program Funding Conversions, and claim Split Billing processes

Coordinates and monitors the completion of all tasks among various operational areas in relation to complex operational projects

Acts as subject matter experts for the analysis and evaluation of claim systems, software, equipment and programs and provides recommendations for implementation.

Assists in the development, testing, and implementation of new and existing programs, procedures, and system enhancements in support of Broadspire Claim and various business departments

Develops and maintains a favorable working relationship with internal and external customers

Coordinates claim system related tasks in conjunction with Finance team for any Break Payment items; maintains and monitors monthly list of clients that are on break payment and reasons

Determines and creates appropriate user access to the Lotus Notes User Distribution Groups

Provides direction to the Claim department for any questions related to handling of Prefund requests and the claim system process impacts

Provides additional user level expertise to ICT Help Desk Support for claim system issues

Oversees ISOVerisk Vendor relationship; i.e., maintains ISO account list, user access IDs, distribution of any ISO error reports, and managing annual fee structure and new product implementation

Analyzes, research and write internal procedural changes, workflows and requirements in support of various business areas Determines business impact and recommends and/or initiates appropriate action

Participates in the research, writing, publishing and maintenance of operating procedures and user manuals

Provides guidance and/or training to Claim Offices on existing claim systems and procedures

Provides assistance to various Broadspire Departments identifying, researching and correction of indicative and financial data errors

Maintains applicable log books as well as adheres to established guidelines of applying reimbursements to claim files and/or mailing of reimbursement/miscellaneous checks to appropriate lockbox

Provides backup coverage to others in Claim Operations as needed and/or requested.

Maintains professional and positive relationship with Boadspires' File Storage Vendor, including ensuring payment of fees and user requirements related to access IDs, file retention, as well as responding to various business area questions or issues

Participates in ad hoc assignments and special projects as assigned

Upholds the Crawford Code of Conduct

Requirements

Three or more years of experience in Broadspire Business Support Services, Claim Systems or Claim Operations or the equivalent, demonstrating a good knowledge of claim systems and field operations.

Education equivalent to graduation from college or the equivalent in related work experience.

Demonstrates effective customer relations skills.

Demonstrates sound analytical skills.

Demonstrates a comprehensive knowledge of claim system functions and the relationship of client information to accurate claim processing and reporting.

Demonstrate ability to work accurately with attention to detail and customer expectations.

Demonstrate effective and diplomatic oral and written communications skills

About Us

Why Crawford?
Because a claim is more than a number - it's a person, a child, a friend. It's anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are... For full info follow application link.

Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.