Claims Operations Specialist: Impactful & Data-Driven

Davies; United States; On-site; USD 34,000 - 44,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

401(k) with employer matching

Paid time off

Job summary

Davies North America, part of the Davies Group, is seeking an Operations Specialist in Santa Ana, CA. This client-facing role ensures timely exchange of information between carrier, underwriting teams, claim handlers, and management to maintain program standards.

The position emphasizes claims data management, quality assurance, and operational support to optimize service delivery and data integrity across the program.

Qualifications

• Experience in insurance, claims administration, underwriting support, program operations, or a related field.
• Strong verbal and written communication with clients, underwriters, and management.
• Excellent organizational skills with the ability to manage multiple priorities in a high-volume environment.
• Proficiency with claims management systems and common business tools.

Responsibilities

• Carrier & Client Communications: serve as primary operational contact for carrier reps and stakeholders.
• Claims Data Management: ensure accurate claim information and document retrieval in systems.
• Program Administration: update guidelines, workflows, and procedures; communicate changes.
• Reporting & Quality Assurance: monitor KPI data and reporting requirements; flag deficiencies.
• Operational Support: assist with audits, data validation, and process improvements.
• Team Support: ensure Medicare compliance checks and timely reporting.

Skills

Insurance/claims operations

Communication skills

Organizational skills

Data accuracy

Interdepartmental coordination

Education

No specific degree required

Tools

Claims management systems

Microsoft Office

Job description

Davies North America, part of the Davies Group, is seeking an Operations Specialist in Santa Ana, CA. This client-facing role ensures timely exchange of information between carrier, underwriting teams, claim handlers, and management to maintain program standards.

The position emphasizes claims data management, quality assurance, and operational support to optimize service delivery and data integrity across the program.