Claims Operations Analyst

vavemga; Chicago, Northern (IL, KY); Hybrid; USD 60,000 - 75,000; Full time

Job summary

vavemga is seeking a role focused on oversight and governance of the US Region Claims team, ensuring timely, accurate, and compliant operations across delegated providers.

The candidate will handle first notice of loss coordination, data quality governance, and ongoing process improvements, working with external partners and internal stakeholders to uphold our claims standards.

Qualifications

• Experience overseeing delegated claims administration and onboarding of DCA’s.
• Strong data governance and quality assurance capabilities.
• Ability to develop and update SOPs to improve processes.

Responsibilities

• Oversee Delegated Claims Administration (DCA) Support and onboarding of DCAs.
• Co-manage first notice of loss handling with claims teams and TPAs.
• Coordinate data quality resolution with US Region Data Operations and governance forums.
• Monitor and improve operational controls and ensure regulatory and internal compliance.
• Oversee annual DCA audits and liaise with internal/external auditors.
• Manage and reconcile loss funds with finance and maintain reporting SLAs.

Skills

DCA Oversight

Data Governance

Quality Assurance

SOPs & Process Improvement

Auditing & Compliance

Cross-functional Collaboration

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