About the roleThe Claims Operation Specialist plays a critical role in managing our claims reporting operations. This position is responsible for the overall claims reporting process to our carrier partners including producing accurate claims bordereaux, creating process improvements and performing thorough reconciliations. The ideal candidate will excel at detailed reporting and data reconciliation, and thrive in a fast-paced environment.
Responsibilities- Own the overall operational process for the production and transmission of accurate, complete, and timely claims bordereaux for carrier partners.
- Elevate claims data into a reliable, decision-driving asset for Finance, Actuarial, and leadership by improving data standards, completeness, and consistency.
- Serve as the operational point of contact for carrier partner BDX inquiries-coordinating responses, root-cause analysis, corrections, and preventive process improvements.
- Drive continuous improvement in data quality and reporting consistency that strengthens trust with carrier partners.
- Oversee claims payment enablement, including invoice processing, reconciliations, and related controls to ensure accuracy, timeliness, and compliance with carrier and regulatory requirements.
- Partner with technology teams to explore and implement Gen-AI and advanced analytics use cases that improve productivity, insight generation, and customer experience.
- Build and maintain operational controls and monitoring to support internal claims audits, carrier partner reviews, and compliance assessments.
- Maintain audit-ready processes, documentation, and evidence to support internal and external reviews.
- Collaborate closely with Claims, Actuarial, Data, Product, and Engineering on strategic initiatives and operational roadmaps.
Skills and Qualifications- 4+ years of experience in insurance claims operations, ideally within a high-growth, dynamic environment.
- Excellent data analysis and systems savvy
- Understanding of insurance concepts
- Customer service, creative problem solving mindset
- Salesforce experience a plus
- Advanced Excel and data management skills, with experience handling large datasets
- Experience as a heavy contributor or leader of a cross functional product/process
- Superior written and verbal communication skills
CompensationOur compensation reflects the cost of labor across several US geographic markets. The US base salary for this position ranges from $75,000/year in our lowest geographic market up to $100,000/year in our highest geographic market. Consistent with applicable laws, an employee's pay within this range is based on a number of factors, which include but are not limited to relevant education, skills, job-related knowledge, qualifications, work experience, credentials, and/or geographic location. Your recruiter can share more on target salary for your location during the interview process. Coalition, Inc. reserves the right to modify this range as needed.
Perks- 100% medical, dental and vision coverage
- Flexible PTO policy
- Annual home office stipend and WeWork access
- Mental & physical health wellness programs (One Medical, Headspace, Wellhub, and more)!
- Competitive compensation and opportunity for advancement
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