CLAIMS COORDINATOR JOB DESCRIPTION

A Claims Coordinator handles the intake, routing, and status tracking of insurance claims across multi-line coverage portfolios that may include general liability, auto liability, workers' compensation, and property. The role sits within a risk management or claims operations function, serving as the primary liaison between injured parties, third-party administrators, adjusters, and internal departments. Accuracy here is non-negotiable. Under frameworks such as OSHA recordkeeping standards and state-specific workers' compensation statutes, an error in claim documentation or a missed filing deadline can expose the organization to regulatory penalties or inflated loss costs.

As the Claims Coordinator, you manage first notice of loss, claim file setup, and ongoing status communication across all active lines of coverage, ensuring each claim moves through the TPA and adjuster workflow in compliance with applicable state and federal requirements. You report to the Risk Management Director or Manager and support a cross-functional group that includes HR, Safety, legal counsel, and field operations teams.

Career Impact: Hands-on management of multi-line insurance claims, including workers' compensation and general liability, builds the technical depth that risk management and insurance operations employers look for when hiring for senior adjuster and risk analyst roles.

Business Impact: Timely and accurate claim filing directly reduces loss reserve exposure and prevents the administrative backlogs that increase total cost of risk for the organization's insured portfolio.

Growth Opportunity: Experience coordinating across TPAs, adjusters, and legal counsel positions you to move into a Risk Management Analyst or Claims Supervisor role as your portfolio complexity and independence grow.

• File first notice of loss with insurance carriers across all applicable lines of coverage within required timeframes.
• Track all open claims in the risk management information system, updating status daily to reflect adjuster actions and resolution milestones.
• Coordinate return-to-work planning with HR and Safety teams for workers' compensation claimants, following applicable state statutes.
• Investigate incident and accident reports by gathering witness statements, photographs, and supporting documentation for adjuster review.
• Review claim submissions from third-party administrators for accuracy, correcting missing or inconsistent data against internal records.
• Monitor OSHA 300 Log entries and submit regulatory reports within mandated deadlines under federal and state recordkeeping requirements.
• Liaise with medical providers, legal counsel, and TPAs to facilitate information exchange and ensure timely claim resolution.
• Identify potentially fraudulent or high-exposure claims and escalate to the Risk Management Director with supporting documentation.

• Bachelor's degree in Risk Management, Business, or a related field, or equivalent work experience.
• 2 or more years of insurance claims administration or risk management experience, with exposure to multi-line coverage including workers' compensation or general liability.
• Working knowledge of OSHA recordkeeping standards, including 300 Log requirements and Bureau of Labor Statistics reporting obligations.
• Demonstrated ability to read and interpret policy language, coverage terms, and state-specific workers' compensation statutes.
• Strong organizational skills with the ability to manage multiple open claims simultaneously and meet filing deadlines without oversight.
• Effective written and verbal communication skills for interaction with adjusters, medical providers, legal counsel, and injured claimants.
• High degree of accuracy and attention to detail in data entry and claim documentation within risk management information systems.
• Proven ability to handle confidential information in compliance with privacy standards and internal data governance policies.

• Associate in Claims (AIC) designation or active pursuit of an adjustor's license in the applicable state.
• Prior experience using a risk management information system such as an RMIS platform for incident tracking and reporting.
• Familiarity with FMLA, ADA accommodation procedures, and their intersection with workers' compensation claim management.
• Bilingual proficiency in Spanish and English, particularly valuable in operations with large field or distribution center workforces.

• OSHA 300 Log entry accuracy rate, measuring compliance with the 7-day recording requirement across all reportable injuries.
• Workers' compensation claim filing timeliness, tracked as percentage of claims filed within the state-mandated deadline.
• Average days to first contact with claimant, reflecting how quickly intake and initial communication are completed.
• TPA data correction rate, measuring how often claim files submitted to third-party administrators require correction after initial review.
• Open claim age distribution, indicating whether the coordinator is actively moving files toward resolution within SLA benchmarks.
• Typical tools: RMIS platforms (commonly Origami Risk or Riskonnect); productivity suites (commonly Microsoft Excel, Outlook, Word).

• Base Salary Range: $45,000 to $62,000 per year, depending on experience and industry sector
• Bonus: Discretionary annual bonus of 3 to 7% of base salary, typically tied to department performance metrics.
• Equity: Not standard for this level; uncommon outside publicly traded insurance carriers
• Health Benefits: Medical, dental, and vision coverage; employer contribution of 70 to 80 percent of premium typical
• PTO: 10 to 15 days annually to start, with accrual increases after two to three years of service
• Common Perks: Professional development reimbursement for AIC or adjuster licensing; mileage reimbursement for site visits

Figures are estimates based on general US market benchmarks and may be outdated. Adjust based on location, company size, and seniority level.

Successful completion of a background check and, where applicable, a credit history review is required as a condition of employment for this role. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other characteristic protected under applicable federal, state, or local law. Reasonable accommodations are available to qualified individuals with disabilities throughout the application and employment process upon request. Candidates must be authorized to work in the United States.

The Claims Coordinator owns the end-to-end review of pending medical claims, matching claim information to appropriate authorizations and preparing cases for clinical review by Medical Directors, UM Nurses, and Case Managers. Working within the claims department and reporting to supervisory leadership, the role builds accuracy and customer satisfaction across all claim types while maintaining a 24-hour turnaround on priority cases.

Key Responsibilities

• Review claims for duplicates, denials, and referrals and ensure that claims information is matched to appropriate authorization.
• Prepare cases for Medical Directors, UM Nurses, and Case Managers to conduct clinical review.
• Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims.
• Provide guidance and act as a resource to trainers and new hires on benefits, contract interpretations, exclusions, eligibility, policies, standard operating procedures, job aids, and workflows.
• Assist with escalated issues, guide as assigned, and maintain prompt turnaround time on all claims, handling priority claims within 24 hours.
• Meet department quality and accuracy standards.
• Interface with other departments to obtain necessary information required for resolution of claims.
• Take ownership of the total work process and provide constructive information to minimize problems and increase customer satisfaction.
• Ensure documentation is completed in appropriate systems.
• Effectively communicate with all Supervisors and Directors.

Required Qualifications

• High School Diploma or GED equivalent required; Associate's Degree in a healthcare-related field preferred.
• Minimum 1 year of experience in the healthcare industry.
• Minimum 6 months of experience in managed care, Prior Authorization, or Claim Review.
• Understanding of medical terminology, ICD-9, and CPT coding.
• Proficient with Medicare processing guidelines.
• Working knowledge of medical contracts.
• Proficient with Microsoft Office applications.
• Exceptional ability to organize, prioritize, and communicate effectively.

Embedded within the claims department, the Claims Coordinator maintains and distributes all incoming data to the appropriate claims team members while managing access security logs for PHI information. Working closely with claim analysts and both internal and external parties, the role delivers accurate processing of Large Claim Notifications and claim payments to keep the department operating with precision and confidentiality.

Core Functions

• Maintain and review all data received by the claims department and distribute to appropriate individuals on the appropriate claims team.
• Maintain and update the security log for access to all PHI data.
• Review and process Large Claim Notifications and deliver to all appropriate parties.
• Record and distribute all claim payments received to the designated claim analyst.
• Assist with filing and other clerical duties as needed.

Qualifications & Experience

• High school degree required; college degree or equivalent experience preferred.
• Proficient with Microsoft Suite products including Word, Excel, Outlook, and Teams.
• Must maintain strict confidentiality.
• Strong organizational skills with the ability to prioritize tasks and meet deadlines.
• Ability to effectively communicate both in writing and verbally.
• Ability to work cooperatively with both internal and external parties.
• Proven ability to multi-task and adjust to changing priorities in a fast-paced environment.
• High attention to detail and eagerness to learn the business model.

Reporting to departmental management, the Claims Coordinator shapes the total cycle claims process by routing claims to appropriate vendors, monitoring daily supplier processing, and developing corrective action plans to maximize recovery. Partnering with vendors and internal teams through ongoing claims meetings and monthly performance reports, the role strengthens claim resolution outcomes and reduces cost exposure across the supply chain.

Primary Duties

• Oversee the total claims cycle process.
• Decipher the nature of claims and route them to the appropriate vendor.
• Ensure expedient filing of claims.
• Manage communication with vendors regarding claim disposition.
• Monitor daily reports to ensure all customer claims are processed with suppliers.
• Conduct ongoing claims meetings to review claim dispositions.
• Analyze claim data to determine root cause.
• Develop corrective action plans to maximize claim recovery.
• Create monthly reports representative of vendor performance.
• Travel to vendor locations as needed.

Skills & Qualifications

• Some college or an associate degree.
• 1 to 3 years of experience in claims or an equivalent combination of education and experience.
• Able to read, analyze, and interpret scientific and technical journals, financial reports, and legal documents.
• Able to respond to inquiries or complaints from customers, regulatory agencies, or members of the business community.
• Strong ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume, and apply concepts of basic algebra and geometry.
• Skilled in defining problems, collecting data, establishing facts, and drawing valid conclusions.
• Able to interpret technical instructions in mathematical or diagram form and manage several abstract and concrete variables.

Sitting at the intersection of claims operations and risk management strategy, the Claims Coordinator leads the day-to-day coordination of incident and claims management programs across all funds, tracking status and reporting outcomes in support of organizational objectives. Operating across internal departments and reporting to risk management leadership, the role delivers operational effectiveness through precise analysis, strong cross-functional collaboration, and proficiency with Risk Management Information Systems.

Duties

• Focus on operational effectiveness in support of claims and risk management strategies.
• Understand and perform claims program policies and procedures for reporting, investigation, analysis, resolution, outcome management, and delivery of claim information.
• Coordinate the day-to-day activities of the incident and claims management program across all funds.
• Track and regularly report the status of claims.
• Develop operational effectiveness in support of claims and risk management strategies.

Requirements

• Minimum 2 years of multi-line insurance claims experience.
• Moderate proficiency with Microsoft Office.
• Prior experience utilizing a Risk Management Information System application.
• Precise analytical skills.
• Ability to perform moderately complex mathematical and financial calculations accurately.
• Strong collaborative and cross-functional leadership ability.
• Strong organizational and interpersonal communication skills.
• Detail-oriented, with strong technical and problem-solving skills.

A key member of the risk management team, the Claims Coordinator delivers accurate intake and daily tracking of insurance claims across all lines of coverage, including general liability, auto liability, property, and workers' compensation. Collaborating across internal information systems and with third-party administrators, the role ensures adjusters receive complete and correct claim data to support timely resolution.

Functions

• Receive and review claim notifications.
• File initial notices of claims with insurance providers for all lines of coverage, including general liability, auto liability, property, and workers' compensation.
• Track all insurance claims in relevant systems, including Excel, ensuring they are kept up to date on a daily basis.
• Produce claim loss runs as requested.
• Review claims reported to third-party administrators for accuracy and provide adjusters with missing or incorrect information, including reviewing internal information systems and direct contact with field leaders.

Experience & Qualifications

• Minimum High School diploma or equivalent college degree preferred.
• Prior work in the insurance space or in a claims handling role.
• Proficient with MS Office products including Excel and Word.
• Demonstrated customer service focus.
• Professional communication skills including email and phone; bilingual preferred.
• Ability to work in a fast-paced environment.

Timely notification, return-to-work coordination, and compliant processing of all Workers' Compensation claims depend on the Claims Coordinator, who implements the Workers' Compensation program across distribution center operations in accordance with established policy, rules, and regulations. Serving as the primary liaison among injured employees, HR, Safety, and the third-party administrator, the role ensures accurate completion of all required DWC forms and supports both light duty and return-to-work programs.

Accountabilities

• Process and provide timely notification and communication with employees, supervisors, and the insurance carrier regarding workers' compensation claims and return to work.
• Implement and manage the Temporary Alternative Work program to ensure facilitation of the light duty program in accordance with established policies.
• Receive and process accident reports and Workers' Compensation claims, and assist with all DWC California forms on time, including wage statements, First Report of Injury, MPN Report, and job information.
• Establish and maintain contact with injured employees and provide assistance with claims and obtaining healthcare as appropriate.
• Provide support to internal and external claims teams on large and complex claims.
• Coordinate Return to Work programs with HR and Safety as appropriate.
• Communicate with Corporate Risk Management, Safety, Human Resources, and the Workers' Compensation third-party administrator.
• Interact with doctors, nurses, and healthcare providers to ensure appropriate processing of claims.
• Work closely with Safety, Human Resources, supervisors, and administrators to facilitate reporting of work-related illnesses, injuries, and return to work.
• Undertake other projects and assignments as needed.

Technical Qualifications

• High school diploma or GED required, some college desired.
• 2 years of California Workers' Compensation claims administration experience.
• Proficient knowledge of Microsoft Office with emphasis on Excel.
• Ability to learn a risk management information system.
• Bilingual in Spanish and English required.
• Ability to professionally communicate with all levels of the organization and external vendors, both orally and in writing.
• Attention to detail and high regard for quality.
• Ability to take responsibility and ownership of deadlines proactively.
• Strong ability to multi-task, prioritize, and build interpersonal relationships.

As the Claims Coordinator, this role shapes the processing and verification of expense claims, advances, and supplier invoices from receipt through resolution in accordance with service level agreements and relocation policy guidelines. The contact center team relies on this work to maintain accurate eligibility determinations, timely invoice verification, and seamless coordination of client communications that support relocation program delivery.

Activities

• Manage expense claims in accordance with relocation policy, including verification and reconciliation of expenses.
• Analyze claims, advances, and supplier invoices to determine if eligibility requirements and claim filing requirements are met, and make corresponding determinations.
• Process all claim types by determining corrective action for various system-generated errors and resolving them.
• Complete invoice verification functions accurately and in a timely manner.
• Deal tactfully with people in a wide variety of situations to convey a favorable corporate image.
• Contact appropriate individuals for urgent and emergency requests to ensure timely handling.
• Identify areas of opportunity and utilize skills and knowledge to suggest improvements.
• Perform data entry and various administrative tasks to support the contact center.
• Provide direction and information to clients and service providers to ensure effective coordination of work.
• Assist the general inquiries team with client communications including chats, emails, phone calls, and voicemails.

Position Requirements

• College graduate or equivalent work experience.
• 1 to 2 years of experience processing client claims.
• Knowledge in relocation, residential real estate, residential mortgages, legal, or banking is an asset.
• Previous experience in a customer support role through a contact center.
• Familiarity with the accounts payable and receivable process.
• Analytical and detail-oriented with effective time management and strong organizational skills.
• Excellent administrative skills including record-keeping.
• Good interpersonal and communication skills with superior customer service orientation.
• Professional self-starter, able to assume additional responsibilities and work flexible hours.
• Bilingualism is preferred.

Claims Coordinator delivers initial case file setup and comprehensive follow-up for life and disability benefit claims, managing applications across Short Term Disability, Long Term Disability, Critical Illness, Accidental Death and Dismemberment, and Life Claims. Success in the position means serving as the first point of contact within the Disability Services Team, building strong relationships with plan members, physicians, and plan sponsors while meeting department deadlines and maintaining confidentiality throughout the case management process.

Operational Focus

• Manage benefit application requests for Short Term Disability, Long Term Disability, Critical Illness, Accidental Death and Dismemberment, and Life Claims.
• Verify and enter completed benefit applications, and follow up with plan members and plan sponsors to obtain further information as required.
• Respond to written and verbal inquiries and prepare correspondence in a variety of formats, including file notes, letters, and reports, for plan members, physicians, providers of care, and plan sponsors.
• Direct escalated client inquiries to the appropriate case manager.
• Serve as a representative initiating and developing strong relationships with both internal and external customers.
• Perform clerical duties such as mail distribution, filing, copying, and collating documents to support the management of case files.
• Oversee payment of invoices, tracking and reporting of claim expenses, and completion of cheque requisitions.
• Prepare and file appropriate income tax information for all plan members.
• Create, review, and update various reports and databases.
• Prioritize and maintain workload to meet deadlines, company objectives, and department standards.

Knowledge, Skills & Abilities

• Post-secondary diploma or certificate in a related field.
• Minimum of 2 years of directly related experience, or equivalent combination of training and experience.
• Experience in health or business-related services, case management, or group benefits considered an asset.
• Demonstrated proficiency in Microsoft Excel and Word, with ability to learn new software easily.
• Excellent written and verbal communication, listening, and interpersonal skills.
• Demonstrated ability to manage changing priorities, maintain confidentiality, and meet deadlines.
• Strong organizational, problem-solving, and decision-making skills with a high degree of accuracy and attention to detail.
• Flexible, innovative, and independent, with a high level of personal accountability and professionalism.
• Demonstrated ability to deal effectively with the public, peers, and co-workers.

The Claims Coordinator produces accurate and confidential processing of all health-related claims for fund and union staff, covering Disability, Hearing, Hospital, Medical, and Vision benefit types in compliance with HIPAA and Protected Health Information guidelines. Responding to incoming inquiries, training staff on updated systems and benefit plans, and interacting with fund departments, this role advances claim resolution quality and ensures staff remains well-informed on eligibility rules and ICD-10 and CPT coding standards.

Key Deliverables

• Process all health-related claims including Disability, Hearing, Hospital, Medical, and Vision for fund and union staff in a timely, accurate, and confidential manner.
• Respond to incoming calls or walk-ins from union and fund staff related to eligibility, benefits, program services, and claims inquiries professionally.
• Make outgoing calls to providers, members, and collection agencies to resolve claim inquiries.
• Complete and submit daily production sheets, reports, and checklists to capture and track incoming and outgoing workflow.
• Protect and maintain all claims-related documents and data to ensure compliance with Protected Health Information and HIPAA guidelines.
• Interact with fund departments to ensure return of requested data and other materials.
• Train new and current employees on systems, benefits, and program services to ensure all staff is well informed on benefit plans, policies, eligibility, claims processes, and related procedures.

Professional Experience

• Bachelor's Degree or equivalent years of work experience required.
• Minimum 2 years of health claims processing experience required, with Quality Control experience preferred.
• Knowledge of eligibility rules including plan benefits and limitations, ICD-10, CPT, and HCPCS coding.
• Basic proficiency in Microsoft Excel and Word, with ability to navigate web-based applications.
• Positive service attitude with high-volume call center and in-person customer service experience preferred.
• Ability to handle sensitive and confidential information with tact and discretion.
• Excellent organizational, interpersonal, and communication skills, both written and verbal.
• Strong attention to detail with ability to work under pressure, multi-task, and prioritize work assignments.
• Bilingual is a plus.

Embedded within the claims and sales support team, the Claims Coordinator oversees accurate and timely intake of new service assignments while collaborating with the sales team to maintain customer retention through high first-time quality rates. Working closely with vendor partners and customers across phone, email, and online channels, the role advances service level agreement compliance and clear cross-team communication throughout the claims process.

Areas of Ownership

• Work as a team to ensure that all customer service level agreements are met.
• Assist the sales team in customer retention by maintaining a high first-time quality rate for all service requests handled.
• Ensure communication between all teams involved is clear and concise.
• Assist customers with submitting their service requests both over the phone and via email and online submission.
• Provide support to customers and their clients regarding claims services.
• Assist vendor partners as needed.

Background & Experience

• General understanding of homeowners' contents claims process.
• Proficient in Microsoft Suite products including Word, Excel, and PDF tools.
• Proficient in the use of helpdesk software and other online platforms as required.
• Ability to communicate clearly in both written and spoken forms.
• Creative problem-solver and critical thinker, able to work independently while contributing to team goals.
• Goal-oriented with strong time management skills and willingness to learn new skills.
• Ability to thrive in a fast-paced environment and multi-task effectively.

Reporting to management, the Claims Coordinator shapes accurate adjudication of pet insurance claims by communicating with insureds, veterinarians, and adoption agencies to gather diagnosis clarifications and supporting documentation. Partnering with internal teams and following established adjudication policies, the role builds claim resolution quality by ensuring proper allocation of deductibles, co-pays, and provider reimbursements while maintaining reliable follow-up and documentation practices.

Role Responsibilities

• Request and communicate with insureds, veterinarians, or adoption agencies for clarification of diagnosis and additional information necessary to accurately process claims.
• Adjudicate for allocation of deductibles, co-pays, co-insurance maximums, and provider reimbursements in accordance with policies and procedures to ensure proper payment.
• Document phone calls in the system and follow up on issues if needed.
• Resolve problems resulting from claim adjudication and communicate claim status and outcomes with insureds.
• Prepare reports as required by management and enter or receive inbound documents as assigned.

Minimum Qualifications

• High school diploma or equivalency required.
• 3 years of veterinary medical experience or equivalency preferred.
• Strong understanding of veterinary medical terminology.
• Proven history of adherence to corporate policies, procedures, and guidelines.
• Excellent tracking, follow-up, and relationship-building skills.

Sitting at the intersection of cargo claims management and legal coordination, the Claims Coordinator leads the investigation of cargo incidents and negotiation of claim settlements with customers and third parties, working with insurers, experts, and lawyers to mitigate losses and contain costs. Operating across logistics, operations, and commercial departments, the role delivers effective resolution of marine insurance claims with a focus on cost savings and cross-functional coordination.

Job Functions

• Identify the origin of the loss and inform concerned parties.
• Handle and investigate cargo incidents and claims.
• Negotiate claim settlements with customers and third parties.
• Provide legal assistance with support from lawyers when necessary.
• Manage cargo incidents with a view to mitigating losses and saving costs.
• Assist the manager with various tasks.
• Coordinate with insurers, experts, lawyers, and internal departments including logistics, operations, and commercial.

Qualifications & Experience

• 1 to 3 years of relevant experience in claims or marine insurance; an internship may be considered.
• Legal or maritime background preferred.
• Excellent level of spoken and written English.
• Ability to work autonomously.
• Strong team player.

A key member of the Resolution Team, the Senior Claims Coordinator refines the ship-to-cash cycle by evaluating and resolving unbilled reports and suspended tasks, identifying root causes across high-dollar and complex scenarios. Collaborating across branch, COE, and SSC staff as well as managers in home infusion, pharmacy, and nursing billing, the role advances timely claims delivery and collection rates while ensuring compliance with federal, state, and local regulations.

What You'll Do

• Actively work on suspended tasks as assigned by the team leader, resolving issues by working with various team members and branch, COE, and SSC staff.
• Perform and provide root cause analysis on suspended tasks.
• Engage other parties as necessary to create a resolution and complete root cause analysis.
• Assist managers and staff from COE, branch, and SSC to resolve suspended issues.
• Ensure compliance with federal, state, and local laws and regulations, policies and procedures, and accrediting body standards.

Education & Experience

• Associate's or Bachelor's degree preferred.
• Minimum 2 years of experience in customer service and in healthcare.
• Experience billing medical claims for home infusion, pharmacy, and nursing.
• Forms management experience including essential patient, prescriber, and payer forms required for billing.
• Payer authorization experience including procuring authorizations, managing tasks, and documenting in relevant systems.
• Suspended report management experience, with demonstrated success in accurate and timely resolution of reports.
• Experience with Microsoft Office, specifically Excel, Outlook, and Word.
• Strong analytical skills, attention to detail, and ability to effectively define complex issues and draw valid conclusions.
• Well-organized, with the ability to effectively prioritize work and communicate across functional settings.

Accurate and compliant processing of inpatient and outpatient claims relies on the Claims Coordinator, who implements administrative systems, conducts first-level investigation and routing of issues, and verifies member eligibility, benefits, and network provider status within designated systems. Serving as a key support resource for the department director and manager, the role enables timely data collection, reporting, and adherence to quality, compliance, and regulatory standards while protecting member privacy.

Day-to-Day Responsibilities

• Provide departmental support by implementing administrative systems, procedures, and practices, and monitoring administrative projects.
• Assist with research projects related to claims and authorizations as directed.
• Conduct first-level investigation and determine appropriate routing of issues, escalating as needed.
• Receive incoming communications from the claims department and route within the department per established guidelines.
• Support the authorization, monitoring, and processing of claims for inpatient and outpatient services by entering data into the designated system and triaging events per department guidelines.
• Maintain data entry requirements by following established workflows and departmental policies and procedures.
• Verify member data by researching eligibility, benefits, network provider status, contracts, and division of financial responsibility.
• Identify barriers to work processes and bring them to the attention of the department manager.
• Run and update daily reports for the department and support data collection, aggregation, and organization.
• Maintain member privacy and protect operations by keeping information confidential and adhering to all quality, compliance, and regulatory standards.

Skills & Qualifications

• High School Diploma or equivalent required; Associate's Degree or equivalent experience preferred.
• Minimum 2 years of relevant experience required.
• Minimum 1 year of medical coding experience required.
• Strong organizational and interpersonal skills, as well as strong written and verbal communication skills.
• Proven ability to multitask and work with limited supervision.
• Ability to provide professional customer service and maintain confidentiality appropriately.
• Ability to work well in a fast-paced and dynamic environment.

As the Claims Coordinator, this role oversees machine transfer processes and warranty claim functions, ensuring data entered into internal IT systems is accurate and complete while identifying system discrepancies through gap analysis. The warranty and distributor operations team relies on this work to measure vendor performance using claim metrics, implement corrective solutions, and support the vendor recovery process across multiple management levels and functions.

Scope of Work

• Manage machine transfer processes and transactions.
• Follow up on requests and conduct necessary research when executing transfers.
• Communicate with distributors on a regular basis regarding processes and procedures.
• Support various warranty and quality functions such as part recalls and distributor development programs.
• Ensure data entered into internal IT systems is accurate and complete.
• Perform gap analysis to identify system discrepancies and develop action plans to correct them.
• Monitor and support the vendor recovery process.
• Measure vendor performance using warranty claim metrics and identify performance gaps with effective solutions.

Skills & Qualifications

• Bachelor's Degree preferred, or 5 years of applicable working experience.
• Working knowledge of electronic data management.
• Well-developed proficiency in MS Excel and other common MS Office products.
• Experience using reporting systems such as Business Objects; SAP skills considered an advantage.
• Strong analytical, quantitative, and problem-solving skills across multiple systems, management levels, and functions.
• Ability to read and interpret documents such as policies, claims, and standard operating procedures.
• Excellent written and verbal communication skills with strong time management skills.
• Willingness to travel domestically up to 10% as required.

Claims Coordinator advances first-notification processing and emergency medical travel assistance for customers under travel insurance plans, documenting all case handling in the claims management system while ensuring compliance with regulatory principles and treating-customers-fairly policies. The work directly supports complaint resolution, Key Performance Indicator delivery, and a proactive outbound call culture that meets defined Service Level Agreements across customer and corporate client relationships.

Work Activities

• Create first notification of claims under travel insurance plans and analyze medical assistance cases.
• Provide assistance and emergency medical travel services to customers, including pre-travel advice, cost containment, identifying recovery opportunities, and liaising with customers, corporate clients, and providers.
• Deliver customer service support regarding policy cover, patient status monitoring, and coordination of travel emergencies, ensuring all case handling is documented in the claims management system.
• Proactively handle escalated calls and ensure complaints are resolved and logged in accordance with business policy and regulatory guidelines.
• Deliver superior customer service while ensuring regulatory principles and processes are followed consistently, including treating customers fairly.
• Assist with the review of processes and potential risks to ensure the department operates efficiently and cost-effectively.
• Deliver agreed Key Performance Indicators to achieve business objectives, including call answer rate, productivity, and quality targets.
• Promote a proactive outbound call culture, setting clear service expectations for all customers and stakeholders.
• Perform independent reviews of policy benefits and approve expenses for assistance cases based on policy interpretation and within authority limits.
• Participate in self-development through quality assurance, case-related training, mentoring, and feedback to team leaders.

Requirements

• Minimum 2 A-levels Grades A-C or equivalent, including recent graduates.
• Minimum 2 years of insurance, international healthcare, or claims handling experience, ideally in a call center environment.
• Proven customer service skills and experience.
• IT and PC literate with demonstrated typing skills.
• Good numeracy, literacy, and attention to detail.
• Fluent written and spoken English, second language desirable.
• Strong communicator at all levels, both verbally and in writing.
• Ability to multi-task and prioritize workload effectively to meet varying tasks and deadlines.
• Self-managed and motivated, with a proactive attitude and effective problem-solving ability.
• Openness to feedback and personal growth.

The Claims Coordinator creates and assigns new claims across full-insurance, accident management, outside total loss, and glass categories, serving as the main point of contact for fleet management customers and groups contacting the Risk Management department. Reporting to Risk Management leadership and collaborating with fleet groups, body shops, and rental vendors, the role coordinates end-to-end claim lifecycle management and directly supports customer retention through accurate, timely communication and resolution.

Performance Expectations

• Serve as the main point of contact for fleet management customers and groups contacting the Risk Management department.
• Act as a liaison between fleet groups, customers, and the Risk Management teams.
• Initiate customer calls upon new customer set-up to develop customized profiles and communicate procedures.
• Administer first report of loss through communication with fleet drivers, fleet contacts, or group personnel.
• Create and assign new claims including full-insurance, accident management, outside total loss, and glass.
• Assign claim status based on initial negligence of the driver and applicable law.
• Refer customers to approved body shops and arrange tows and rentals with continual follow-up through the repair process.
• Extend substitute rentals and finalize billing for payment as needed.
• Follow up with repair shops to confirm vehicle arrival, repair time calculation, and validation of downtime.
• Communicate claim status with customers and groups, including recovery efforts, repair, and rental status.
• Research and communicate billing questions, errors, and concerns as needed.
• Handle after-hours payments for release of vehicles upon request.

Experience & Qualifications

• Bachelor's Degree preferred.
• Must have or be willing to obtain an Associate in Claims or Adjuster's License.
• Minimum 2 years of administrative, professional office, or customer service experience.
• Successful client communication experience, including difficult and adversarial conversations.
• Previous risk management, insurance industry, or claims experience preferred.
• Intermediate proficiency with Microsoft Excel, Word, and Outlook.
• Proven success in negotiation and problem and conflict resolution.
• Demonstrates honesty, integrity, and a strong attention to detail with the ability to thoroughly review information for accuracy.
• Effective communicator both verbally and in writing, with strong presentation skills.
• Committed to excellent performance, self-motivated, and able to adapt readily to change.

Reporting to the Director of Risk Management, the Claims Coordinator coordinates workers' compensation filing, incident documentation, and return-to-work assignments while recording all incident and accident reports in the RMIS system within defined regulatory timeframes. Working closely with HR, Safety Committee members, TPA adjusters, and medical providers, the role elevates organizational risk management performance through accurate OSHA reporting, liability claims documentation, and ongoing training for managers on accident and incident reporting procedures.

Core Responsibilities

• Record all incident and accident expeditiously reports in the RMIS system.
• Review security incident reports for occurrences requiring follow-up or potential claim documentation.
• Determine whether occurrences are captured as incidents or submitted as claims, and determine OSHA recordability status where applicable.
• Alert the Director of Risk Management to potentially fraudulent claims, changes in claim status, and other trends or concerns as they become apparent.
• Maintain awareness of current workers' compensation laws, OSHA recording standards, and other applicable safety and insurance topics.
• File workers' compensation claims within three calendar days.
• Conduct or participate in investigations, including obtaining photographs and witness statements, and provide findings to the adjuster.
• Assist employees with completion of paperwork and claim-related questions.
• Work with medical providers to ensure effective exchange of workers' compensation medical information for successful claims and invoice processing.
• Coordinate return-to-work assignments for injured employees, escalating to Risk Management and HR when permanent restrictions or ADA accommodations are anticipated.
• Document all potential liability claims submitted by guests and auto loss claims in the RMIS system, and interface with TPA claims adjusters to facilitate investigation.
• Maintain and update Risk Management databases, forms, and tables for data gathering, information tracking, and legal purposes.
• Compile comparative statistical information for tracking and trending Risk Management performance.
• Provide accident and incident report training for managers individually or in group settings.
• Participate in the Safety Committee and Accident Review Team, including root cause analysis and preventive action implementation.

Technical Qualifications

• Claims administration processing experience is a plus.
• Understanding of general accounting principles required.
• Knowledge of medical terminology desirable, including familiarity with FMLA and ADA.
• Experience with Microsoft Office products, including Word, Excel, Outlook, and PowerPoint required, or ability to learn in the short term.
• Strong technical writing and editing, and business communication skills both written and verbal.
• Good organizational skills and ability to work independently to complete assigned tasks in a timely, professional, and confidential manner.
• Ability to develop and maintain positive and productive relations with the workforce, outside medical resources, and insurance adjusters.
• Must possess or obtain a valid driver's license and comply with the company vehicle policy.