Claims Operations Analyst

Jobtailor; Chicago (IL); On-site; USD 90,000 - 120,000; Full time

Job summary

Jobtailor in Chicago seeks an experienced Claims Operations Manager to oversee the US Region Claims team, including offshore partners and TPAs. You will drive governance, data quality, and lifecycle improvements across claims processes.

Lead onboarding of delegated claims administrators, manage loss funds, audits, and reporting, and coordinate with Finance and external auditors to ensure regulatory compliance and strong internal controls.

Qualifications

• Experience leading claims operations and governance for risk and regulatory alignment.
• Strong data analysis and QA practices to ensure data integrity across the lifecycle.
• Proven ability to manage third-party providers and TPAs in a regulated environment.

Responsibilities

• Oversee technical and administrative support to the claims team.
• Govern offshore partners and service providers for the US Region Claims team.
• Manage onboarding of delegated claims administrators and administer contracts.

Skills

Operational Claims Management

Data Analysis

Regulatory Compliance

Quality Assurance

Third-Party Management

Tools

Origami Risk

Job description

Provide oversight, technical and administrative support to the claims team.
Oversee technical support, quality oversight, and governance of offshore partners.
Oversee service providers and outsource partners supporting the US Region Claims team.
Manage onboarding of new delegated claims administrators and administer DCA contracts.
Co-manage first notice of loss and reports of loss to excess carriers.
Set up open market Cyber claims in Origami Risk and assign them to adjusters.
Refer notices of loss to the appropriate TPA or claim handler.
Coordinate resolution of claims bordereaux data quality issues and represent Claims Operations in data governance forums.
Monitor data integrity and enhance operational controls, escalating discrepancies and proposing remediation plans.
Review and update claims standard operating procedures.
Support the US Claims team with stakeholder queries and requirements.
Oversee the internal claims peer review process and provide monthly status reports.
Contribute to projects and transformational work aligned with strategic priorities.
Manage fiscal controls supporting the claims function.
Maintain and enhance claims lifecycle processes for accuracy, timeliness, and compliance.
Coordinate annual DCA audits and liaise with internal and external auditors.
Set up and administer loss funds, including replenishments, top-ups, cash calls, and reconciliations.
Liaise with Finance and act as a loss fund referral point for TPAs, brokers, and external stakeholders.
Manage the end-to-end loss fund process in accordance with policies and procedures.

Requirements

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

Core Competencies

Demonstrates expertise in Operational Claims Management, Data Analysis, and Regulatory Compliance while effectively overseeing claims processes and ensuring data integrity. Strong communication and stakeholder management skills are essential for coordinating with internal and external partners.

Highest-signal resume keywords

• Operational Claims Management
• Data Analysis
• Regulatory Compliance
• Quality Assurance
• Third-Party Management

Hard Skills

• Business Intelligence
• Data Analysis
• Quality Assurance
• Process Management
• Internal Controls

Soft Skills

• Communication
• Customer Relationship Management
• Escalation Management

Industry Keywords

• Claims Operations
• Governance
• Claims Lifecycle
• Fiscal Controls
• Data Governance

Tools & Technologies

• Origami Risk