Claims Operations Specialist

IntePros; Philadelphia (Philadelphia County); On-site; USD 34,440 - 41,328; Part time

Job summary

A leading IT consulting company is seeking a Claims Operations Specialist to serve as a liaison, ensuring accurate benefit configuration and timely resolution of inquiries. In this role, you will manage multiple benefit-related tickets, analyze configurations, and communicate effectively with various stakeholders. Ideal candidates will have 3-5 years of experience and strong analytical skills. The position offers a competitive hourly pay rate in a temporary capacity with a focus on customer satisfaction.

Qualifications

• 3–5 years of related professional experience.
• 4+ years of health insurance claims processing experience.
• Ability to interpret complex benefit structures.

Responsibilities

• Act as primary point of contact for benefit-related inquiries.
• Manage incidents ensuring resolution within established SLAs.
• Conduct in-depth research to validate benefit setup.

Skills

Analytical skills

Problem-solving skills

Communication skills

Proficiency in Microsoft Office

Job description

Base pay range

$25.00/hr - $30.00/hr

The Claims Operations Specialist serves as a key liaison between the business and multiple internal departments, ensuring accurate benefit configuration and timely resolution of benefit‑related inquiries. This role supports all lines of business and market segments, including Fully Insured and Self‑Funded plans, and plays a critical role in maintaining benefit accuracy, operational alignment, and customer satisfaction.

Key Responsibilities

• Act as the primary point of contact for benefit‑related tickets submitted by Customer Service, Operations, Claims, Sales, Member Appeals, and Executive teams.
• Review, triage, and manage incidents across all lines of business and market segments, ensuring resolution within established internal SLAs.
• Conduct in‑depth research across multiple systems to validate client, product, and benefit setup.
• Utilize core applications such as FOS, CSIW, Health Rules Payor, and Product Configurator to investigate and resolve benefit discrepancies.
• Analyze benefit rules and configurations to identify root causes and recommend corrective actions.
• Prepare clear, accurate, and professional written responses with supporting documentation for key, high‑visibility, and executive‑level inquiries.
• Facilitate cross‑functional discussions to align stakeholders on benefit rules, configuration, and interpretation.
• Ensure consistent understanding and application of benefit logic across departments.

Qualifications

• 3–5 years of related professional experience.
• 4+ years of health insurance claims processing experience.
• Strong analytical and problem‑solving skills with the ability to interpret complex benefit structures.
• Proven ability to communicate complex concepts clearly to both technical and non‑technical audiences.
• Proficiency in Microsoft Office applications.

Seniority level

Associate

Employment type

Temporary

Job function

Information Technology

Industries

IT Services and IT Consulting