Claim Operations Associate I

Summit; Lakeland (FL); Hybrid; USD 40,000 - 55,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

401(k) with company match

Paid time off

Tuition reimbursement

Job summary

SCI Summit Consulting, LLC is seeking a claims processing professional in Lakeland, FL. The role requires careful review of claim documents, data entry, and collaboration with adjusters and leadership to ensure timely, accurate processing.

You will handle routine inquiries, maintain records, and support QA while adhering to privacy standards and company policies. The position blends on-site work with one remote day to support client service excellence.

Qualifications

• - Develops knowledge of local, state, and federal insurance-related policies.
• - Develops analytical and organizational abilities with a focus on prioritization.
• - Develops working knowledge of claim data processing systems.

Responsibilities

• Process and review claim-related documents for completeness, accuracy, and compliance with company procedures.
• Perform data entry and maintain claim information within multiple claims management systems.
• Update existing claim records in a timely manner.
• Provide administrative and operational support to claims adjusters, supervisors, and leadership teams.
• Respond to routine inquiries from customers, policyholders, claimants, agents, vendors, and internal business partners.
• Assist with the collection, organization, and distribution of claim documentation, including correspondence, reports, invoices, and supporting records.
• Monitor assigned workflows and queues to ensure service level agreements and departmental performance standards are met.
• Review incoming claim correspondence and route information to the appropriate team members for action.
• Maintain records to support claims processing activities.
• Identify discrepancies, missing information, or processing issues and elevate concerns as appropriate.
• Ensure compliance with company policies, regulatory requirements, and privacy standards when handling sensitive customer information.
• Support quality assurance activities by reviewing files for accuracy and adherence to established procedures.
• Coordinate with internal departments to obtain necessary claim information and documentation.
• Maintain organized electronic records and documentation in accordance with records retention requirements.
• Participate in training programs and ongoing development activities to enhance knowledge of claims processes and systems.
• Contribute to process improvement initiatives by identifying opportunities to increase efficiency and improve customer experience.
• Meet departmental productivity, quality, accuracy, and customer service performance expectations.
• Perform other duties and special projects as assigned.
• Great American ’s culture is built on connection, shared learning, and strong relationships. To support this, employees in this role are expected to be on-site four days a week, with the flexibility to work one day remotely. Core in-office days are Tuesday –Thursday, with the fourth day determined by business needs.

Skills

Analytical thinking

Organizational skills

Communication skills

Education

High school diploma

Tools

Claims management systems

Job description

Company

SCI Summit Consulting, LLC

Summit provides independent insurance agents and their clients with market-leading workers’ comp insurance and elite customer service. We’re growing and currently serve more than 7,000 independent agents and 31,000 policyholders across the South, Midwest, and Mid-Atlantic.

Our strength comes from a single-minded focus on workers’ comp and a commitment to long-term customer relationships. Summit is who you turn to when you need a specialist who not only knows workers’ comp but also gets to know your business and your priorities.

Our field team members are located in every state in which we operate.

Summit is a member of the Great American Insurance Group where our highest goal is for all employees to feel included, respected, and empowered to perform at their best.

This position is not eligible for employment visa sponsorship. Applicants must be authorized to work in the United States without the need for current or future sponsorship.

Essential Job Functions And Responsibilities

• Process and review claim-related documents for completeness, accuracy, and compliance with company procedures.
• Perform data entry and maintain claim information within multiple claims management systems.
• Update existing claim records in a timely manner.
• Provide administrative and operational support to claims adjusters, supervisors, and leadership teams.
• Respond to routine inquiries from customers, policyholders, claimants, agents, vendors, and internal business partners.
• Assist with the collection, organization, and distribution of claim documentation, including correspondence, reports, invoices, and supporting records.
• Monitor assigned workflows and queues to ensure service level agreements and departmental performance standards are met.
• Review incoming claim correspondence and route information to the appropriate team members for action.
• Maintain records to support claims processing activities.
• Identify discrepancies, missing information, or processing issues and elevate concerns as appropriate.
• Ensure compliance with company policies, regulatory requirements, and privacy standards when handling sensitive customer information.
• Support quality assurance activities by reviewing files for accuracy and adherence to established procedures.
• Coordinate with internal departments to obtain necessary claim information and documentation.
• Maintain organized electronic records and documentation in accordance with records retention requirements.
• Participate in training programs and ongoing development activities to enhance knowledge of claims processes and systems.
• Contribute to process improvement initiatives by identifying opportunities to increase efficiency and improve customer experience.
• Meet departmental productivity, quality, accuracy, and customer service performance expectations.
• Perform other duties and special projects as assigned.
• Great American ’s culture is built on connection, shared learning, and strong relationships. To support this, employees in this role are expected to be on-site four days a week, with the flexibility to work one day remotely. Core in-office days are Tuesday –Thursday, with the fourth day determined by business needs.

Job Requirements

Education: High School Diploma (Associates degree preferred).

Scope of Job/Qualifications: Develops knowledge of local, state, and federal insurance-related policies. Develops analytical and organizational abilities with a focus on prioritization. Develops working knowledge of claim data processing systems. Demonstrates interpersonal and communication skills.

Benefits

We offer competitive benefits packages for full-time and part-time employees*. Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement. Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits.

Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. Learn more at http://www.gaig.com/careers.

• Excludes seasonal employees and interns.

Company

SCI Summit Consulting, LLC