Claims & Risk Assurance Analyst

Jackson Healthcare, LLC; Alpharetta (GA); Hybrid; USD 70,000 - 95,000; Full time

Job summary

Jackson Healthcare is seeking a Corporate Risk and Claims Specialist to handle end-to-end claims processing, verify coverage, and coordinate with carriers and internal teams. You will conduct quality reviews, apply QA frameworks, and support audits to ensure accuracy and compliance.

You will also serve as a primary contact for claimants and partners, documenting interactions, tracking timelines, and driving improvements in claims workflows.

Qualifications

• Bachelor's degree in Risk Management, Finance, Business Administration, or a related field required; equivalent combination of education and experience considered.
• 3 - 5 years of progressive experience in claims administration, insurance operations, or a related field required.
• Experience with claims management systems and quality assurance processes required.
• Demonstrated knowledge of property, casualty, or workers compensation claims processing required.
• Strong organizational skills and ability to manage a claims workload independently.

Responsibilities

• Manage end-to-end claims intake and processing, including claim logging, coverage verification, adjuster assignment, and documentation collection.
• Evaluate claim submissions for coverage applicability, completeness, and compliance with policy requirements; elevate complex coverage questions appropriately.
• Monitor open claims for timely resolution; coordinate with adjusters, carriers, and internal stakeholders to advance claim progress.
• Maintain accurate claims records in the claims management system; ensure data integrity and timely updates.
• Conduct quality reviews of claims files to verify accuracy, completeness, and compliance with internal standards and regulatory requirements.
• Apply quality scoring frameworks to evaluate adjuster performance and claims handling outcomes; summarize findings for supervisor review.
• Support internal audit processes by preparing claims file samples, organizing documentation, and tracking audit findings.
• Recommend process improvements based on quality review observations and recurring deficiency patterns.
• Serve as a point of contact for claimants, internal departments, adjusters, and carriers on routine claims matters.
• Communicate claim status, coverage determinations, and resolution timelines clearly and professionally.
• Coordinate documentation exchanges between internal and external parties to support timely claims resolution.
• Prepare claims status summaries and correspondence as required by the claims team or business partners.
• Identify gaps in claims processes and recommend workflow improvements to the Senior Corporate Risk and Claims Specialist.
• Produce routine claims reports including volume, cycle time, open claim aging, and quality metrics.
• Support special projects and ad hoc analyses as assigned by senior team members.

Skills

Claims management

Quality assurance

Regulatory compliance

Communication

Problem solving

Teamwork

Education

Bachelor's degree in Risk Management

AIC designation preferred

Tools

Claims management systems

Quality assurance tools

CRM systems

Job description

Jackson Healthcare is seeking a Corporate Risk and Claims Specialist to handle end-to-end claims processing, verify coverage, and coordinate with carriers and internal teams. You will conduct quality reviews, apply QA frameworks, and support audits to ensure accuracy and compliance.

You will also serve as a primary contact for claimants and partners, documenting interactions, tracking timelines, and driving improvements in claims workflows.