Claims Administrative Specialist

Key Responsibilities

• Prepare legal and claim-related report packages and electronically compile documents, including excess reporting materials
• Support litigation processes, including defense referrals and document submissions to legal partners
• Compile and organized claim documentation from multiple systems for internal and external requests
• Accurately document completed tasks and updates within multiple claim and document management systems
• Process and resolve returned mail, including re-routing and reissuing correspondence as needed

• Request, track, and follow up on medical records, police reports, and other external documentation
• Maintain logs and status updates for outstanding records requests to ensure timely receipt

• Prepare, generate, and distribute state-required forms and standard claim correspondence
• Create and issue benefit notices and required communications in compliance with jurisdictional timelines
• Request and process wage statements, medical authorizations, and acknowledgment letters
• Complete index inquiry forms and other required administrative documentation
• Ensure timely and accurate delivery of outgoing communications to appropriate parties

• Process claim related payments within the claims system based on adjuster direction
• Set up and manage recurring (auto) payments in accordance with disability durations and medical guidance
• Generate associated benefit notices and ensure proper documentation of payment activity
• Support preparation and distribution of payout and financial reports

• Prepare regulatory transactions (EDI) based on claim activity
• Monitor submission queues, track filing status and ensure timely and accurate reporting
• Identify and resolve errors or rejections and resubmit corrected transactions

• Manage high-volume administrative tasks across multiple systems and workflows
• Track, prioritize, and complete assigned tasks within established service level agreements (SLAs)
• Navigate and update multiple systems to ensure accurate and timely task completion
•  Identify and escalate exceptions, discrepancies, or time-sensitive issues

• Provide timely and professional support to internal teams and external stakeholders
• Communicate clearly and effectively, both verbally and in writing
• Respond to inquiries and follow up on outstanding requests as needed

• Perform other administrative tasks and special projects as assigned to support the claims organization
• Assist in cross-functional support as business needs evolve

Skills, Knowledge and Expertise

• Strong attention to detail and accuracy in administrative and data entry tasks
• Ability to manage multiple priorities in a high-volume, deadline-driven environment
• Experience working with document management systems and claims platforms preferred
• Basic understanding of property and casualty and workers’ compensation processes, forms, and terminology preferred
• Proficiency in Microsoft Office and other business systems
• Excellent written and verbal communication skills
• Strong organizational and problem-solving abilities