Claims Operations Associate I

The Claims Operations Associate I is an entry-level support role responsible for assisting with the setup, processing, and administration of workers' compensation claims. This position serves as a key member of the Claims Operations team, helping to ensure claims are accurately established, information is properly documented, and customer inquiries are addressed in a timely and professional manner.

The role works closely with claims professionals and business partners while developing foundational knowledge of workers' compensation and insurance operations.

This is a remote, work-from-home position. Candidates must reside within the Pacific Time Zone and be available to work 37.5 hours a week from 8:00 a.m. to 4:30 p.m. Pacific Time, Monday through Friday.

- Respond to customer, claimant, and internal inquiries via phone, email, and voicemail in a timely and professional manner.

- Set up and enter new claims while ensuring information is complete and accurate.

- Review claim submissions and documentation to identify discrepancies or missing information.

- Utilize claim management and workflow systems to track activities, manage workload, and maintain organization.

- Verify coverage information and assist with basic claim administration tasks.

- Process and support routine claim-related transactions in accordance with established procedures.

- Investigate and gather information needed to resolve straightforward questions and service requests.

- Document claim activity accurately and maintain detailed records within applicable systems.

- Assist with creating and distributing general correspondence and claim-related communications.

- Collaborate with claims professionals and operational partners to support efficient claim handling.

- Escalate non-routine or complex issues to management or senior team members for resolution.

- Maintain productivity and service standards while working in a remote environment.

- Demonstrate professionalism, accuracy, and attention to detail in all interactions and work products.

- Support special projects and perform additional duties as assigned.

- Experience in claims operations, claims processing, billing support, customer service, policy services, or a related insurance support role required.

- Basic understanding of insurance concepts, terminology, and business processes.

- Strong verbal and written communication skills with the ability to effectively interact with internal and external customers.

- Demonstrated ability to work accurately, manage multiple priorities, and learn new systems and processes.

- Must reside within the Pacific Time Zone, be available during standard Pacific business hours, and be self-motivated in a remote work environment.