Insurance Operations Specialist

🕒 Setembro 2

🎸 Tennessee – Remoto

🎸 Tennessee – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

⚙️ Operações

🦅 Patrocina Visto H1B

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👻 Score fantasma 37%

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American Addiction Centers

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2012

💼 Consultoria

🛡️ Seguros

📦 Logística

Consulting • Insurance • Logistics

A American Addiction Centers é a principal fornecedora de serviços de tratamento de dependência nos Estados Unidos, especializada em tratamentos baseados em evidências para dependência de drogas e álcool, bem como em questões de saúde mental e comportamental. Com uma rede de instalações, oferecem suporte personalizado e recursos para recuperação, facilitando o acesso das pessoas aos cuidados de que precisam. Comprometida em ajudar aqueles que lutam contra a dependência, a American Addiction Centers também fornece ferramentas para verificar a cobertura de seguro e garantir opções de tratamento acessíveis para os pacientes.

Descrição

• Receive and triage notices of incidents, claims, demands, lawsuits, administrative charges, and other potentially insured matters • Gather incident reports, supporting documentation, correspondence, and information for complete claim files • Enter new claims and maintain current claim information in claims management and internal tracking systems • Coordinate timely reporting and tender to carriers, TPAs, and brokers, escalating as needed • Maintain organized claim files and retain documentation throughout each matter’s lifecycle • Track open claims, significant dates, follow-ups, mediations, hearings, settlement payment dates, reporting deadlines, and other milestones • Follow up on open claims and outstanding requests, escalating unresolved matters or those requiring management attention • Review open claims for stale matters, incomplete records, missing updates, unresolved action items, and potential closure • Communicate with carriers, TPAs, brokers, adjusters, and outside counsel regarding claim administration • Coordinate with facility leadership and internal departments to obtain requested medical records, personnel information, and incident documentation • Track information and documentation requests through completion or escalation • Identify matters requiring additional review and bring significant developments, delays, or unresolved issues to Legal or Company leadership • Track service of process, attorney correspondence, administrative filings, mediations, settlements, and other significant claim events • Maintain records of claim status, reserves, legal spend, settlements, and final disposition • Confirm claim closure and maintain complete final claim records • Prepare claim summaries, litigation reports, insurance reports, and other claim-related information • Support insurance and claims information requests for audits, due diligence, transactions, renewals, and organizational initiatives • Reconcile and validate claim information across internal systems, carrier and TPA reports, and other records • Recommend improvements to claim intake, tracking, documentation, and follow-up processes • Collaborate with Legal, Human Resources, facility leadership, Finance, and other corporate departments • Maintain confidentiality of sensitive claim, employee, patient, legal, and business information • Perform other duties as assigned

🎯 Requisitos

• High school diploma or equivalent required • Relevant professional experience may substitute for formal education • Minimum of 3 years of experience in claims administration, insurance operations, workers’ compensation administration, insured litigation support, or a related function required • Experience communicating and coordinating with insurance carriers, TPAs, brokers, claims adjusters, and/or outside counsel strongly preferred • Commercial insurance claims experience preferred • Healthcare, behavioral health, or multi-state claims experience is a plus • Experience using a claims management system, RMIS, matter-management system, or similar tracking platform preferred • Strong proficiency with Microsoft Office and/or Google Workspace • Ability to maintain accurate trackers, reports, electronic files, and claim documentation • Exceptional organizational skills and attention to detail • Ability to manage a high volume of claims, deadlines, follow-ups, and competing priorities • Initiative and ability to follow through on outstanding matters • Ability to work with limited supervision in a high-volume environment • Discretion and sound judgment with sensitive, confidential, and potentially privileged information • Strong problem-solving skills • Ability to review and understand claim-related documentation, including incident reports, demand letters, legal correspondence, lawsuits, administrative filings, insurance information, and settlement documentation • Clear and professional communication with internal stakeholders and external insurance and legal partners • Ability to maintain accurate and complete records • Ability to work collaboratively across Legal, Human Resources, Finance, and other functional areas • Prolonged sitting at a desk • Must be able to lift 15 pounds at a time

🏖️ Benefícios

• Work/life balance • Investment in education • Company matching 401K • Medical insurance • Dental insurance • Vision insurance • Life insurance • Equal opportunity employment • Reasonable accommodations for disabilities

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