Claims Operations Specialist (Hybrid)

Claims Operations Specialist (Contract)

Beacon Hill’s client is seeking a detail-oriented and customer-focused Claims Operations Specialist to join their Benefit Distribution team. This is an excellent opportunity for someone who thrives in a fast-paced environment, enjoys investigating claims, and is passionate about delivering outstanding service to customers.

The team is committed to processing claims accurately, efficiently, and with compassion while maintaining high service standards and exceeding customer expectations.

Position Details

• Pay: $25-$27/hour, depending on experience
• Schedule: Monday-Friday, 8:00 AM – 4:45 PM (with a 45-minute unpaid lunch break)
• Location: Hybrid – only 1 day per week onsite in the St. Paul office, 4 days remote otherwise (Equipment provided for remote days)
• Duration: Contract

Key Responsibilities

• Review and assess claims using available resources, documentation, and investigative techniques to reach accurate claim determinations.
• Analyze claim information, identify discrepancies, and apply critical thinking skills to support sound claim decisions.
• Communicate claim progress and updates to customers and other interested parties throughout the review process.
• Determine claim outcomes based on investigation findings and approve applicable benefit payments.
• Document claim decisions thoroughly, including supporting rationale for approvals or denials.
• Draft detailed correspondence explaining denial decisions and policy-related determinations when necessary.
• Verify claim files are complete, accurate, and contain all required forms, documentation, and supporting records.
• Manage a high volume of claims while consistently meeting established service-level and turnaround expectations.
• Respond to inbound phone inquiries regarding claim status, policy provisions, coverage details, and exclusions.
• Maintain quality standards and provide a positive customer experience while adhering to compliance and operational guidelines.

Qualifications

• Experience with living benefits claim processing or related insurance claims administration.
• Exceptional attention to detail and ability to maintain accuracy in a fast-paced environment.
• Strong analytical and problem-solving capabilities.
• Sound judgment and decision-making skills.
• Excellent written and verbal communication skills.
• Strong organizational and time-management abilities.
• Positive, empathetic, and customer-focused approach.
• Ability to work successfully both independently and as part of a collaborative team.
• Comfortable learning new systems, processes, and technology platforms.
• Passion for providing high-quality customer service and support.