Claims Operations Specialist
2 weeks ago
The Claims Operations Specialist serves as a key liaison between the business and multiple internal departments, ensuring accurate benefit configuration and timely resolution of benefit-related inquiries. This role supports all lines of business and market segments, including Fully Insured and Self-Funded plans, and plays a critical role in maintaining benefit accuracy, operational alignment, and customer satisfaction. Key Responsibilities Act as the primary point of contact for benefit-related tickets submitted by Customer Service, Operations, Claims, Sales, Member Appeals, and Executive teams. Review, triage, and manage incidents across all lines of business and market segments, ensuring resolution within established internal SLAs. Conduct in-depth research across multiple systems to validate client, product, and benefit setup. Utilize core applications such as FOS, CSIW, Health Rules Payor, and Product Configurator to investigate and resolve benefit discrepancies. Analyze benefit rules and configurations to identify root causes and recommend corrective actions. Prepare clear, accurate, and professional written responses with supporting documentation for key, high-visibility, and executive-level inquiries. Facilitate cross-functional discussions to align stakeholders on benefit rules, configuration, and interpretation. Ensure consistent understanding and application of benefit logic across departments. Qualifications Bachelor's degree or equivalent relevant experience. 3–5 years of related professional experience. 4+ years of health insurance claims processing experience. Strong analytical and problem-solving skills with the ability to interpret complex benefit structures. Proven ability to communicate complex concepts clearly to both technical and non-technical audiences. Proficiency in Microsoft Office applications.
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Claims Operations Specialist
2 weeks ago
Philadelphia, PA, United States IntePros Full timeThe Claims Operations Specialist serves as a key liaison between the business and multiple internal departments, ensuring accurate benefit configuration and timely resolution of benefit-related inquiries. This role supports all lines of business and market segments, including Fully Insured and Self-Funded plans, and plays a critical role in maintaining...
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Claims Operations Specialist
3 weeks ago
Philadelphia, PA, United States IntePros Full timeThe Claims Operations Specialist serves as a key liaison between the business and multiple internal departments, ensuring accurate benefit configuration and timely resolution of benefit-related inquiries. This role supports all lines of business and market segments, including Fully Insured and Self-Funded plans, and plays a critical role in maintaining...
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Health Operations Claims Specialist
2 weeks ago
Philadelphia, PA, United States IntePros Full timeThe Claims Operations Specialist serves as a key liaison between the business and multiple internal departments, ensuring accurate benefit configuration and timely resolution of benefit-related inquiries. This role supports all lines of business and market segments, including Fully Insured and Self-Funded plans, and plays a critical role in maintaining...
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Claims Operations Specialist
2 weeks ago
Philadelphia, United States IntePros Full timeThe Claims Operations Specialist serves as a key liaison between the business and multiple internal departments, ensuring accurate benefit configuration and timely resolution of benefit-related inquiries. This role supports all lines of business and market segments, including Fully Insured and Self-Funded plans, and plays a critical role in maintaining...
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Claims Operations Specialist
3 weeks ago
Philadelphia, United States IntePros Full timeThe Claims Operations Specialist serves as a key liaison between the business and multiple internal departments, ensuring accurate benefit configuration and timely resolution of benefit-related inquiries. This role supports all lines of business and market segments, including Fully Insured and Self-Funded plans, and plays a critical role in maintaining...
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Claims Operations Specialist
2 weeks ago
Philadelphia, PA, United States IntePros Full timeThe Claims Operations Specialist serves as a key liaison between the business and multiple internal departments, ensuring accurate benefit configuration and timely resolution of benefit-related inquiries. This role supports all lines of business and market segments, including Fully Insured and Self-Funded plans, and plays a critical role in maintaining...
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Claims Operations Specialist
1 week ago
Philadelphia, PA, United States IntePros Full timeThe Claims Operations Specialist serves as a key liaison between the business and multiple internal departments, ensuring accurate benefit configuration and timely resolution of benefit-related inquiries. This role supports all lines of business and market segments, including Fully Insured and Self-Funded plans, and plays a critical role in maintaining...
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Claims Operations Specialist
2 weeks ago
Philadelphia, United States IntePros Full timeThe Claims Operations Specialist serves as a key liaison between the business and multiple internal departments, ensuring accurate benefit configuration and timely resolution of benefit-related inquiries. This role supports all lines of business and market segments, including Fully Insured and Self-Funded plans, and plays a critical role in maintaining...
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Claim Specialist
1 week ago
Philadelphia, Pennsylvania, United States State Farm Full time $64,965 - $99,000OverviewBeing good neighbors – helping people, investing in our communities, and making the world a better place – is who we are at State Farm. It is at the core of how we operate and the reason for our success. Come join a #1 team and do some goodGrow Your Skills, Grow Your PotentialResponsibilitiesJoin our team as a Property Field Inspection Claim...
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Trucking Claims Specialist
1 week ago
Philadelphia, PA, United States Berkshire Hathaway GUARD Insurance Companies Full timeOverview Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren...
