Claims Operations Specialist 2

Job Summary
The position provides project oversight and subject matter expertise in support of the Claims business unit goals and objectives, as well as leadership in developing processes to increase the effectiveness of the operations. This involves duties that ensure compliance with government regulations and financial accuracy. In addition, this position produces statistical reports and analyses along with technical assistance in identifying system issues. When systems issues have been identified, participate in testing business and functional processes, provide recommendations for solutions to the identified issue, and ensure accuracy.

Job Duties

• Produce highly complex reports regarding claims data to determine trends. Report data to regulatory agencies. Demonstrate proficiency and experience with reporting solutions.
• Document and research systems issues and coordinate with Information Systems to resolve. Design and implement work flow to meet business and regulatory requirements. Ensure system changes satisfy regulatory, corporate, and business unit’s requirements.
• Track corporate assets that are assigned to claims business unit. Subject matter expert on external/internal Club/Claim applications and systems. Liaison with other business units on matters such as Finance, Underwriting, Corporate Cashiering, Insurance Accounting, and Purchasing.
• Function as the team lead on daily operations and special projects to ensure accuracy and timeliness. Provide project oversight and subject matter expertise for programs and processes specific to Claims Business Unit. Train and mentor other Claims Specialists.
• 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.
• Special projects to support department and corporate goals. Complete audits. Club/Claims applications user. Participate and attend meetings as liaison to other Business Units on matters concerning Finance, Underwriting, Corporate Cashiering, Insurance Accounting, and Purchasing.
• Quality review of new vendor set up (tracking of required forms and fields) for correctness and completeness to generate payments. Process levies against vendors. Process child support liens. Track over payments reimbursement from vendors. Claims accounting for overpayments. Research unidentified recoveries.
• Ensures accuracy and appropriateness of basic user profile data for claim systems and support applications. Participates in internal /external financial and systems audit.
• Works with Insurance Accounting, Corporate Banking and Finance to reconcile and post money recoveries to identify discrepancies. Reconcile banks statements. Process annual 1099 for claims vendors and resolve 1099 disputes. Complete payment corrections. Process unclaimed claims payments to the appropriate state governmental agency. Vendor EFT set up.
• Develop the most appropriate processing alternatives to meet user, regulatory and system requirements.
• Determine if exceptions are a result of a system program, equipment or user error. Determine how to best resolve exceptions.
• Contribute to a detailed analysis of claims data.
• Ensure integrity of financial and claim file data transactions processed through the claims systems.
• Work is performed under minimal supervision and requires extensive knowledge in recognized claims operations practices, techniques and methods in area of expertise. Work regularly requires the exercise of discretion and independent judgment in making recommendations or directly addressing an issue. Develops solutions to a variety of complex problems.

Qualifications

• Bachelors Equivalent combination of education and experience Preferred
• 7-9 years Claims operations or related experience Preferred
• Advanced PC skills required.
• Microsoft Office: Excel, Word, Access, Publisher and PowerPoint
• Experience with Club software programs preferred (Claims Portal, Business Objects, CACS, PRIME, HUON, etc.).
• Excellent organization and planning skills required.
• Superior oral and written communication skills required.
• Outstanding interpersonal skills required.
• Advanced analytical skills
• Broad knowledge of operational responsibilities

Scope

• Work is accomplished with limited direction. Determines and develops approach to solutions. Work is evaluated upon completion to ensure objectives have been met.
• Provides resolution to a diverse range of recognizable complex problems. Analysis is required to identify root cause. Uses judgment within defined boundaries to develop alternate solutions, both long and short term. Problem/Task resolution timeframe: Inclusive of shorter timeframes, but typically the majority of tasks take three to six months to resolve.
• Plans and arranges own work, refers only unusual cases to supervisors or others.
• Individual Contributor
• Failure to obtain results or erroneous judgments or recommendations would normally have serious results and may require substantial expenditure of resources to correct and/or achieve goals.
• Contacts are frequently inter-organizational and outside customer/vendor interactions.  Part of a team who represents the organization. Monitors activities and communicates information across the organization

The starting pay range for this position is:

Additionally, for full time positions, you will be eligible to participate in our incentive program based upon the achievement of organization, team and personal performance.

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Remarkable benefits:
•    Health coverage for medical, dental, vision
•    401(K) saving plan with company match AND Pension
•    Tuition assistance
•    PTO for community volunteer programs
•    Wellness program
•    Employee discounts

“Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”

AAA is an Equal Opportunity Employer

The Automobile Club of Southern California will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance (FCIHO), the Unincorporated Los Angeles County (ULAC) regulation, and the California Fair Chance Act (CFCA).