Claims Operations Specialist: Customer-Driven & Data-Savvy

Wells Media Group; Lake Oswego (OR); On-site; USD 45,000 - 75,000; Full time

Benefits offered by this job

Health Insurance

401(k) retirement match

Paid Time Off

Wellness Program

Volunteer Encouragement

Job summary

Travelers in Lake Oswego, OR is seeking a Customer Service Representative to support the claims team in handling customer inquiries, payments, and information management. You will work under supervision with claim professionals to ensure timely resolution and accurate data handling.

The role emphasizes effective communication, diligent documentation, and collaboration across departments to maintain service quality and compliance.

Qualifications

• Experience utilizing computer technology such as Microsoft Office, e-mail, Web-enabled applications, and database software.
• ACCOUNTABILITY: Takes ownership and responsibility for actions and outcomes, performance and results.
• ANALYTICAL THINKING: Ability to analyze and compare information to understand issues and explore alternative solutions.
• CHANGE MANAGEMENT/RESILIENCE: Ability to remain energized and focused in the face of ambiguity, change or strenuous demands.
• COMMUNICATION SKILLS: Verbal and written communication skills.
• JUDGMENT/DECISION MAKING: Ability to exercise sound judgment and make decisions.
• RELATIONSHIP MANAGEMENT: Ability to seek out, build, foster and maintain productive working relationships to meet goals and achieve results.

Responsibilities

• CUSTOMER ENGAGEMENT: Serves as a customer service representative for the claim department by promptly and professionally addressing customer questions and concerns, which may include: Triage and route callers to the appropriate department; Answers claim status and payment questions.
• CLAIM OPERATIONAL SERVICE AND PARTNERSHIPS: Partners with claim professionals in multiple departments to assist with the timely resolution of claims, which may include: Properly documents claim files, including notes and diaries, Requests reports and records, and reviews medical bills, mail and wage statements. Prints and prepares claim documents for legal and medical reviews. Reports and assigns claims, and transitions closed files to and from off-site storage. Receives, sorts, scans, and uploads incoming mail, and processes out-going mail. Orders, receives and distributes supplies and/or equipment.
• CLAIM PAYMENTS AND EXPENSE PROCESSING: Ensures the proper handling of financial transactions to include: Processes and issues claim payments including outside vendor invoices, attorney expenses, and medical processing fees. Processes and documents returned checks, voided checks and credits. Ensures timeliness and accuracy of all check processing.
• DATA AND INFORMATION MANAGEMENT: Maintains accurate records and information management, such as: Prepares, generates and reviews reports using the most effective technology. Updates data discrepancies identified in reports and systems. Uses management information data to prepare line of business or financial reports. Prepares operational reports for claim professionals and managers. Accurately documents pending and completed work activities using appropriate systems.
• FINANCIAL CONTROLS AND ASSESSMENTS: Assists with claim center financial standards, including: Performs underlying controls and effectively communicates findings. Assesses the reasonableness of data as well as identifying discrepancies, including reconciliations. Assesses the effectiveness of financial controls. Prepares data entries in accordance with established standards.
• May require lifting items up to 20 pounds (occasionally).
• Perform other duties as assigned.

Skills

Accountability

Analytical thinking

Change management

Communication skills

Judgment/decision making

Relationship management

Education

High School Diploma

Bachelor’s Degree

Tools

MS Office

Email

Web-enabled applications

Database software

Job description

Travelers in Lake Oswego, OR is seeking a Customer Service Representative to support the claims team in handling customer inquiries, payments, and information management. You will work under supervision with claim professionals to ensure timely resolution and accurate data handling.

The role emphasizes effective communication, diligent documentation, and collaboration across departments to maintain service quality and compliance.