# Operations Specialist **Company**: Davies **Location**: Santa Ana, California **Work arrangement**: remote **Job type**: full-time **Category**: Insurance **Industry**: Insurance **Apply**: https://davies.pinpointhq.com/en/postings/1d1b049e-2a5e-430f-823a-ff8b0611e309?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply **Canonical**: https://yubhub.co/jobs/job_495a0af3-921 ## Description The Operations Specialist is a client-facing role responsible for claims support, serving as a key liaison among the carrier, underwriting teams, claim handlers, and management. ### Key Responsibilities #### Carrier & Client Communications - Serve as a primary operational point of contact for carrier representatives, underwriters, and other program stakeholders. - Coordinate with the carrier’s underwriting teams to obtain risk codes, policy information, classifications, bordereau data, and other information required for accurate claim reporting. - Communicate with the carrier as claims are received and follow up promptly when information or documentation is incomplete. - Facilitate timely communication among the carrier, management, and claim handlers regarding program requirements, data needs, and operational issues. #### Claims Data Management - Review newly received claims and ensure required claim information is obtained and accurately entered into the claims management system. - Retrieve policies, claim documents, and related materials from the carrier’s portal or other designated systems. - Organize, upload, and maintain documents within the claims management system in a clear and consistent manner. - Monitor claim data for accuracy and completeness and follow up on missing or inconsistent information. #### Program Administration - Maintain and update program guidelines, workflows, reference materials, and operating procedures. - Work with the carrier and claim handlers to ensure carrier requirements and procedural updates are clearly communicated and consistently implemented. - Identify operational issues, coordinate with appropriate stakeholders, and assist in developing practical solutions. - Support the implementation of new reporting requirements, process changes, and program enhancements. #### Reporting & Quality Assurance - Maintain and support key performance indicator (KPI), bordereau, and other carrier reporting requirements. - Monitor performance against applicable reporting standards, service expectations, and program requirements. - Identify deficiencies, trends, or recurring issues and communicate them to management in a timely manner. - Assist management in implementing training, updated procedures, or corrective actions when necessary. #### Operational Support - Provide day-to-day operational assistance to claim handlers and management. - Assist with special projects, audits, file reviews, data validation, and program-related initiatives. - Support workflow management and process improvement efforts designed to enhance service delivery, data quality, and claim handler efficiency. - Perform other duties and provide additional support as needed to meet program and business requirements. #### Team Support - Provide Medicare Compliance support including checking eligibility and meeting reporting deadlines. - Check payee names in the OFAC system to clear for check issuance. - Maintain a small pending of settled claims and report to carriers. ### Skills, Knowledge & Expertise #### Required: - Experience in insurance, claims administration, underwriting support, program operations, or a related field. - Working knowledge of insurance terminology, policy information, and claims processes. - Excellent organizational skills, with the ability to manage multiple priorities and meet deadlines in a high-volume environment. - Strong verbal and written communication skills, including the ability to communicate professionally with clients, underwriters, claim handlers, and management. - High level of attention to detail and commitment to data accuracy and complete documentation. - Proficiency with claims management systems, Microsoft Office applications, carrier portals, and related business tools. #### Preferred: - Experience working with delegated authority, third-party administrator (TPA), managing general agent (MGA), or carrier program business. - Familiarity with bordereau reporting, KPI monitoring, and insurance data management. - Experience working directly with underwriting and claims teams. - Experience supporting specialty insurance programs or transportation and environmental claims operations. ### Benefits - Medical, dental, and vision plans - A 401(k) plan with employer matching - Time-off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non-exempt employees - Paid holidays - Life insurance and short-term and long-term disability coverage ## Skills ### Required - insurance - claims administration - underwriting support - program operations - claims management systems - Microsoft Office applications - carrier portals ### Nice to have - delegated authority - third-party administrator (TPA) - managing general agent (MGA) - carrier program business - bordereau reporting - KPI monitoring - insurance data management --- Source: [Apply at davies.pinpointhq.com](https://davies.pinpointhq.com/en/postings/1d1b049e-2a5e-430f-823a-ff8b0611e309?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)