Claims Operations Analyst

Socket.dev; Chicago (IL); On-site; USD 60,000 - 75,000; Full time

Job summary

Socket.dev is seeking a Claims Operations Lead to oversee delegated claims administration, data governance, and quality assurance for the US region. You will coordinate onboarding of DCA partners, manage first notice of loss, and ensure accuracy across data and procedures.

You will work closely with Finance, Legal, and Data Operations to drive process improvements, audits, and monthly reporting while maintaining regulatory compliance and strong stakeholder relationships.

Qualifications

• Experience in claims operations and governance.
• Strong data governance and QA focus.
• Excellent stakeholder management.

Responsibilities

• Provide delegated claims administration (DCA) oversight for service providers and outsource partners.
• Co-manage first notice of loss handling with claims team and external carriers/TPAs.
• Coordinate data quality across bordereaux and data operations teams; implement controls.
• Maintain and review claims SOPs to ensure processes are optimal and compliant.
• Oversee annual DCA audits and act as liaison for internal/external auditors.
• Manage loss funds setup, replenishments and reconciliations with finance and DCAs.
• Support fiscal controls and reporting to ensure timely, accurate claims processing.
• Lead transformation projects and drive process improvements within Claims Operations.

Skills

Business Intelligence

Communication

Customer Relationship Management

Data Analysis

Escalation Management

Internal Controls

Operational Claims Management

Process Management

Quality Assurance

Regulatory Compliance

Third-Party Management

Tools

Origami Risk

Job description

The Role

To provide oversight, technical and administrative support to the claims team in a professional, timely and fair manner and to ensure that you deliver excellent customer service to both our internal and external customers.

To oversee and provide technical support and quality oversight and governance of our offshore partners

To act in accordance with, drive, and further the aims set out in the claims promise: Our aim is to push the boundaries of customer service excellence through an empowered, collaborative and innovative approach to claims that makes us the envy of the market.

Responsibilities

Delegated Claims Administration (DCA) Support

• Ensure effective oversight of service providers or outsource partners, who provide services to the US Region Claims team, flagging any issues of concern and proposing a plan to remediate.
• Manage the onboarding of new DCA’s when required in collaboration with Group Claims Operations and various functional stakeholders (e.g. Legal, Finance, Data Operations).
• Administration of DCA contracts

First Notice of Loss Handling

• Work in collaboration with the Claims Assistant to co-manage first notice of loss and reports of loss to excess carrier.
• For open market Cyber claims, set up the new claim in Origami Risk and assign to the appropriate adjuster.
• For all other programs, refer the notice of loss to the appropriate TPA/claim handler.

Data and Quality Assurance

• Coordinate and assist with resolution of all claims bordereaux data quality issues in collaboration with the US Region Data Operations team and/or Group Claims as necessary.
• Represent Claims Operations in data governance forums, ensuring data quality standards are met and supported by appropriate controls.
• Monitor data integrity across operational processes and elevate discrepancies as needed.

Operational Support

• Monitor and where appropriate enhance controls, ensuring they are working effectively across the team. To the extent that any controls fail, report this as appropriate and propose remediation plans.
• Continually review and update all claims SOP (standard operating procedures), specifically to ensure our processes are optimal and, are being followed.
• Support the US Claims team in proactively managing and addressing any ad hoc queries or requirements from either internal or external stakeholders.
• Successfully oversee the internal claims peer review process to ensure our annual plan is met, and any performance issues are raised, including the provision of monthly status reports.
• Make proactive and meaningful contributions to all project and transformational work per the team’s strategic priorities.
• Work with the Claims Operations team to manage fiscal controls required to support the claims function.
• Maintain and enhance operational processes that support the claims lifecycle, ensuring accuracy, timeliness, and compliance with regulatory and internal standards.

Audit Support

• Coordinate and oversee annual DCA audits and support the adjusters in their review of claims files as necessary.
• Act as the liaison contact for our internal/external auditors.

Loss Fund Oversight

• Coordinate the set up new loss funds for new/existing DCA’s.
• Oversee the administration of existing loss funds, including increases to existing loss fund amounts, e monthly replenishment/top ups and cash calls.
• Ensure that loss funds reconciliation documents requested from DCAs are received in line with reporting requirements and SLAs.
• Liaise with Finance regarding loss fund reconciliations, and ensuring appropriate funds are held in our FCP account.
• Act as a loss fund referral point for TPA/brokers and other external stakeholders.
• Perform loss fund reconciliation monthly.
• Manage the end-to-end loss fund process (legacy, current and future (FCP)), ensuring that they are maintained in accordance with the policy and procedures and where any potential issues are identified, obtain full details prior to reaching a firm decision on resolution.

Skills

• Business Intelligence
• Communication
• Customer Relationship Management
• Data Analysis
• Escalation Management
• Internal Controls
• Operational Claims Management
• Process Management
• Quality Assurance
• Regulatory Compliance
• Third-Party Management

Salary Range: $60,000 - $75,000