Insurance Operations Specialist

🔥 12 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

🦅 H1B Visa Sponsor

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👻 Ghost score 10%

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American Addiction Centers

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

💼 Consulting

🛡️ Insurance

📦 Logistics

Consulting • Insurance • Logistics

American Addiction Centers is the leading provider of addiction treatment services across the United States, specializing in evidence-based treatment for drug and alcohol addiction as well as mental and behavioral health issues. With a network of facilities, they offer personalized support and resources for recovery, making it easy for individuals to access the care they need. Committed to helping those struggling with addiction, American Addiction Centers also provides tools to verify insurance coverage and ensure accessible treatment options for patients.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

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