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Insurance Claims Operations Specialist
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The Executive Claims Specialist role at HDI Global Insurance Company is a critical position that involves overseeing the day-to-day supervision of programs or captives whose claims are handled by a Third Party Claims Administrator (TPA). This individual will be responsible for account management, providing leadership and support to both HDI personnel and TPA personnel.
Main Responsibilities- Communicate directly with TPA to address and resolve issues or concerns, as well as resolve complaints in a timely and professional manner.
- Audit a representative sampling of each TPA and program's claims at least once per year, including a formal written report and meeting to present results.
- Ensure that claims are being processed expeditiously, and that all inventories are regularly reviewed, with all possible actions taken to move the claims to closure.
- Work with the HDI Claims team to constantly improve TPA claim handling processes, systems, communications, and overall program effectiveness.
- Provide guidance and direction to TPA's on complex claim handling, strategy, or negotiation and resolution.
- In the event of a catastrophe requiring a ramp-up and response, support efforts to prepare the staff.
