CLAIMS OPERATIONS SPECIALIST JOB DESCRIPTION

The P&C insurance market runs on two things: accurate claim records and the operational rigor to keep them moving. When either falters, statutory reporting deadlines slip, adjuster licensing lapses go undetected, and payments to policyholders stall. The Claims Operations Specialist exists to prevent that. Sitting within the claims department, this role owns the administrative and data integrity layer that allows licensed claim professionals to focus on coverage decisions. It demands both precision in high-volume data entry and enough compliance awareness to support state-by-state adjuster licensing records and regulatory audit preparation.

The mandate of the Claims Operations Specialist is to maintain the operational infrastructure of the claims department, from claim file setup and payment processing to compliance documentation and reporting, so that claim resolution timelines stay on track. A team of claims professionals, a Claims Leader or COO, and external partners, including insurance company partners and auditors, depend on this role's output across multi-line and catastrophe claim events.

Career Impact: Hands-on exposure to P&C claim lifecycles, statutory reporting, and multi-line claim operations builds a practical compliance and data foundation that carries directly into Claims Examiner and Claims Adjuster roles.

Business Impact: Accurate payment processing, timely adjuster licensing maintenance, and audit-ready documentation directly determine whether claim settlements reach policyholders on schedule and whether the department clears regulatory review.

Growth Opportunity: Specialists who develop proficiency in process mapping and data analysis within this seat are well-positioned to advance into Claims Operations Specialist II or quality assurance roles that carry expanded scope across markets.

• Set up and maintain claim files, records, and compliance documentation to meet internal and external insurance operations standards.
• Process inbound recovery payments and outbound claim payments, including invoices, attorney expenses, and check corrections, with accuracy and timeliness.
• Prepare and generate monthly, quarterly, and ad hoc reports for claim professionals and Claims Leadership using claim management systems.
• Maintain current adjuster licensing records for each state where the claims team operates.
• Support Claims Leadership with audit facilitation, meeting coordination, and managerial report preparation.
• Coordinate mail intake, document scanning, and electronic file management to keep the claims department paperless and organized.
• Transcribe recorded statements and prepare correspondence on behalf of the claims department for internal and external parties.
• Identify workflow inefficiencies and recommend process improvements to Claims Leadership to support department optimization goals.

• Bachelor's degree in business, finance, or a related field, or equivalent work experience.
• 2 or more years of claims or insurance operations experience, with demonstrated proficiency in high-volume data entry and document management.
• Working knowledge of insurance compliance requirements, including state adjuster licensing and statutory reporting standards.
• Proven ability to prepare and reconcile financial data, including claim payments, expense reports, and FSA entries.
• Strong written and verbal communication skills for correspondence with brokers, attorneys, and internal business partners.
• High attention to detail and the ability to manage multiple concurrent claim files under deadline pressure.
• Ability to assess compliance with internal procedures, regulatory policies, and legal requirements without direct supervision.

• Prior experience with claims management platforms used in P&C or multi-line environments, expressed as operational competency rather than platform familiarity.
• Exposure to catastrophe claim support operations or multi-line claim administration, including CAT-event workflow coordination.
• Experience with process documentation, including creation of workflow maps, audit checklists, or training materials for claims teams.
• Data analysis experience sufficient to identify discrepancies in claim reports and escalate findings to Claims Leadership.

• Claim file setup accuracy rate, reflecting completeness and timeliness of records entered per established standards.
• Payment processing error rate, measuring the frequency of check corrections, voids, or credits against total payments issued.
• Adjuster licensing compliance rate across all states where the claims team holds active licenses.
• Audit readiness score, tracking whether compliance documentation passes internal and external review without material findings.
• Report delivery timeliness, measuring whether monthly, quarterly, and ad hoc reports are delivered on schedule to Claims Leadership.
• Typical tools: Claims management platforms (commonly ImageRight or similar); document management and reporting (commonly Microsoft Office Suite, including Excel and Access).

• Base Salary Range: $42,000 to $58,000 annually, depending on experience and market
• Bonus: Discretionary annual bonus, typically 5% to 8% of base salary
• Equity: Not typical for this level in insurance operations roles
• Health Benefits: Medical, dental, and vision coverage; employer contribution varies by carrier
• PTO: 15 to 20 days annually, plus standard US federal holidays
• Common Perks: Licensing fee reimbursement, professional development support, hybrid or in-office flexibility depending on employer

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

Background check completion, including verification of employment history and, where applicable, credit history consistent with insurance industry standards, is a condition of employment. All qualified applicants will receive consideration 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 applicants and employees with disabilities upon request. Candidates must be authorized to work in the United States.

The Claims Operations Specialist delivers accurate claim data entry, correspondence handling, and financial transaction support across one of the organization's largest operational teams, building a claims experience recognized for fairness and efficiency. Reporting to claims leadership and collaborating with business partners, this role ensures workflows remain current and claim records are complete and properly maintained.

Key Responsibilities

• Follow established workflows and assist with their maintenance.
• Open and sort incoming mail and triage to the associated party.
• Submit outbound mail packages to external customers and business partners.
• Review inbound recovery payments and log entries into the claims dashboard.
• Manually enter claim data and create records, documents, and attachments where needed.
• Retrieve relevant information for claim handling using third-party applications when requested.
• Prepare correspondence and deliver or initiate routine correspondence.
• Support the claims team with various projects, duties, and ad hoc assistance as needed.
• Assist business partners with inquiries around financial transactions and other necessary information.
• Transcribe recorded statements accurately and efficiently.
• Witness documents as a notary public to support the claims department.

Required Qualifications

• High school diploma or GED required.
• Experience in an office environment.
• 1 or more years of experience in a claims environment.
• Proficient in Microsoft Office Suite and Google Workspace, including Gmail, Docs, and Sheets.
• Proven ability to manage time effectively, multitask, and communicate with customers.
• High sense of professionalism while remaining empathetic, and strong attention to detail.
• Ability to approach problems with an open mind and build collaborative working relationships.
• Effective communicator and collaborator in a matrixed environment.
• Self-starter who can work independently and prioritize work effectively.
• Comfortable handling ambiguity and adapting quickly when changes occur.

Embedded within the claims department, the Claims Operations Specialist owns claim file setup, state adjuster licensing maintenance, and compliance documentation to keep operations aligned with internal and external insurance standards. Working closely with the Claims Leader and insurance company partners, this role prepares managerial reports, coordinates audits, and manages the full scope of shared team records.

Core Functions

• Set up new claim files and organize existing claim files within the claims management system.
• Prepare monthly internal and external claims reports.
• Assist claims team members with individual reporting requirements, including documentation for and assistance with expense reports.
• Maintain records to ensure current claims professionals' licensing for each state.
• Maintain documentation related to compliance matters and ensure team performance is consistent with internal and external insurance operations standards.
• Set up and maintain compliance-related reports as requested or required by internal or external review teams.
• Assist the Claims Leader with daily tasks, including preparation and dissemination of managerial reports and ongoing and ad hoc projects and insurance company partner requests.
• Coordinate and schedule internal and external meetings on behalf of the Claims Leader.
• Facilitate and set up internal and external audits.
• Prepare communication to internal and external parties on behalf of the Claims Leader.
• Assist the Claims Leader with the budget process.
• Maintain the claims team's electronic and paper shared documents, files, and folders.

Qualifications & Experience

• High school diploma required, college degree a plus.
• 2 or more years in a similar position or office setting with a good understanding of office procedures.
• Knowledge of basic accounting concepts and the ability to solve practical problems.
• Proficient in Microsoft Office Suite, especially Word, Outlook, and Excel.
• Experienced with multiple systems and software, including document scanning in a paperless office environment.
• Demonstrated good judgment in adhering to business and personnel guidelines.
• Ability to multitask effectively in a fast-paced environment.

Reporting to claims management, the Claims Operations Specialist II shapes how auto physical damage claims are resolved by capturing workflows, producing best-practice process documents, and delivering data analysis that supports department optimization. Partnering with Finance, Underwriting, Corporate Cashiering, Insurance Accounting, and Purchasing as a cross-functional liaison, this role advances operational consistency across all markets.

Primary Duties

• Capture current detailed workflows related to the various contingencies in resolving auto physical damage claims.
• Produce highly detailed process documents and guidelines that capture best practices to be applied across all markets.
• Document activity triggers within the claims portal and vendor portals.
• Provide actionable information to claims management through analysis of data elements and relationships.
• Assist in developing new strategies to support department goals and optimization objectives.
• Support special projects aligned with department and corporate goals.
• Complete audits as required.
• Participate in meetings as liaison to other business units on matters concerning Finance, Underwriting, Corporate Cashiering, Insurance Accounting, and Purchasing.

Skills & Qualifications

• Bachelor's degree or equivalent combination of education and a minimum of 5 years of related work experience preferred.
• Prior claims handling experience, including early response and auto physical damage, is highly desirable.
• Broad knowledge of operational responsibilities within a claims environment.
• Data analysis experience preferred.
• Advanced analytical skills.
• Advanced skills in Microsoft Office.
• Experienced with claims management systems and reporting tools, including Business Objects.
• Excellent organization, planning, interpersonal, oral and written communication skills.

Sitting at the intersection of reinsurance claims handling and technical accounting, the Claims Operations Specialist owns the receipt, recording, and settlement of Excess of Loss claims while supporting underwriting administration and proportional contract monitoring for the Reinsurance Operations team. Operating across property and casualty lines and reporting to the COO/Head of Claims, this role communicates directly with brokers and cedents to ensure accurate exposure recording and catastrophe loss aggregation.

Duties

• Handle the receipt, recording, and settlement of Excess of Loss reinsurance claims.
• Accurately capture information on the status of Excess of Loss claims and provide monitoring functions on claim information reported on proportional contracts.
• Capture pertinent claim details and confirm coverage on reinsurance programs and layers to accurately record exposures on a per-claim basis and monitor aggregation of catastrophe loss.
• Assist in the support of program reinsurance business flowing through the organization.
• Communicate directly with brokers and cedents in support of the underwriting team.
• Participate in client reinsurance claim audits as required.

Education & Experience

• Bachelor's degree or equivalent combination of education and experience.
• Minimum of 5 years of reinsurance claims and operations experience, preferably in both property and casualty.
• Knowledge of reinsurance programs, Excess of Loss structures, proportional contracts, and catastrophe loss aggregation.
• Technologically savvy and data-driven.
• Proficient in MS Office Suite, with experience in specialized reinsurance policy administration and accounting software, including SICS NT a plus.
• Strong written and verbal communication skills, including ability to explain complex issues and interpret abstract information.
• Proven ability to proactively manage time and workload to meet tight deadlines.

A key member of the Home Lending Operations team, the Claims Operations Specialist leads proof-of-claim preparation, loan history research, and bankruptcy document review to facilitate the transition of loans to closure. Collaborating across Legal, Control partners, and multiple internal lines of business, this role identifies efficiency opportunities and ensures every file is documented accurately and on time.

Functions

• Prepare proof of claims timely and accurately.
• Perform extensive research into loan histories.
• Utilize numerous system applications and stay current on updates to those systems.
• Monitor databases for assigned caseload.
• Assist peers with identifying and addressing complex loan histories as part of a team.
• Communicate process issues with management.
• Identify areas for efficiency gains and develop strategies for implementation.
• Partner effectively with multiple lines of business, including Legal and Control partners.
• Review and analyze bankruptcy documents and work with attorneys to meet deadlines.
• Document the system with appropriate action and follow up on each file.

Requirements

• Experience in default processing or a related field.
• Knowledge of compliance requirements, including procedures, policies, legal, and regulatory requirements.
• Proficient in Microsoft Office Applications.
• Proven ability to quickly adapt to change and apply new processes and concepts.
• Strong attention to detail and focus on accuracy.
• Skilled at analyzing and communicating issues not addressed in established procedures.
• Effective time management and organizational skills.
• Ability to work effectively in a team environment and maintain a professional demeanor.

The Claims Operations Specialist builds and maintains process maps, training materials, and quality remediation plans that enable front-line claims staff to maximize productivity across auto, physical damage, and bodily injury claim lines. Based within the claims organization and collaborating with claims leadership and the vendor management team, this hybrid role advances measurable business process improvements and coaches staff to execute at a high level of quality.

Accountabilities

• Analyze and measure the effectiveness of existing business processes and develop sustainable, repeatable, and quantifiable business process improvements, including building and maintaining process maps and documents.
• Design claims processes focused on eliminating waste and improving data quality, and train the claims team to execute these processes with a high level of quality.
• Collaborate with claims leadership to design, test, and launch technology solutions that drive claims efficiency and improve the claims experience.
• Drive quality file handling by targeting opportunity areas in process, compliance, and execution, and provide coaching and feedback to improve performance.
• Identify training and process improvement opportunities and develop training plans and process documentation in response.
• Identify quality opportunities with external partner files and develop remediation plans in collaboration with the vendor management team to improve quality and performance.
• Design, develop, and maintain training materials used within the claims organization.
• Modify established training materials to tailor training needs for targeted audiences.

Professional Experience

• 3 or more years of experience in insurance claims, specifically involving auto, physical damage, and bodily injury claims, with leadership experience preferred.
• Quality assurance or training experience preferred.
• Proficient in designing processes and creating flowcharts.
• Proficient in Google Sheets and Microsoft Excel.
• Strong analytical and prioritization skills, particularly in fast-moving environments.
• Strong communication and presentation skills.
• Creative problem-solving ability with experience engaging multiple stakeholders.
• Experience working in a technology or start-up environment preferred.