Corporate Risk and Claims Specialist

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

Overview

Jackson Healthcare and our family of companies provide healthcare systems, hospitals and medical facilities of all sizes with the skilled and specialized labor and technologies they need to deliver high quality patient care and achieve the best possible outcomes - while connecting healthcare professionals to the temporary engagements, contract assignments and permanent placement employment opportunities they desire. Headquartered in metro Atlanta, we’re powered by more than 2,600 associates and over 20,000 clinician providers covering all 50 U.S. states. Our mission is to improve the delivery of patient care and the lives of everyone we touch. This includes the patients, clinicians and healthcare executives we work with through our companies every day, as well as our communities, the nonprofit organizations we support and each associate who is part of our family. We’re always looking to add new talent to our teams. We value diverse professionals at all levels and across multiple disciplines and areas of expertise, who have strong leadership skills, align with our culture, and are committed to excellence.

Corporate Risk and Claims Specialist

The Corporate Risk and Claims Specialist is an Individual Contributor responsible for the daily execution of provider Risk Reviews, malpractice Claims Verification, and Claim administration across the Jackson Healthcare family of companies. Jackson Healthcare's core business is placing physicians, nurses, and other healthcare providers in clinical settings across the United States on a short-term basis; each of the 22 Jackson companies sources and credentials these providers through a rigorous screening process. This role is the engine of that process, evaluating escalated provider files, confirming loss-history and claims exceptions, and coordinating state-level PCF enrollments, all while applying sound judgment, process discipline, and meticulous attention to detail. The Corporate Risk and Claims Specialist partners closely with company representatives, an external enrollment vendor, and insurance entities to ensure timely, accurate, and audit-ready outcomes.

ESSENTIAL RESPONSIBILITIES

Claims Administration & Processing

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.

Risk Reviews (Quality Assurance/Underwriting)

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.

Stakeholder Communication & Coordination

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.

Process Improvement & Reporting

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.

QUALIFICATIONS

EDUCATION, WORK EXPERIENCE, CERTIFICATIONS REQUIRED

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.

PREFERRED

Associate in Claims (AIC) designation preferred. Experience with quality assurance or audit processes in an insurance or risk environment preferred. Knowledge of regulatory requirements applicable to claims handling preferred.

KNOWLEDGE, SKILLS, AND ABILITIES

Technical Skills:

Demonstrates solid working knowledge of claims management systems, quality review tools, and insurance policy interpretation. Independently processes standard claims and applies best practices in coverage evaluation and quality assurance. Troubleshoots routine claims issues and escalates complex matters appropriately.

Problem-Solving & Innovation:

Handles problems of a moderate scope requiring a review of a variety of innovative factors. Applies Company policies and procedures to resolve a variety of issues; identifies the most effective path to resolution.

Quality & Decision-Making:

Optimal results are submitted with fewer corrections. Management will oversee work to identify areas of improvement. Exercises judgment within defined procedures for best results, balancing accuracy, timeliness, and compliance.

Communication:

Effective communication builds productive internal and external working relationships. Clearly conveys risk information, insurance status, and claims updates to business partners, carriers, and internal stakeholders.

Teamwork & Mentorship:

Receives little instruction on daily work and new assignments and engages with the team. Collaborates with cross-functional partners including legal, finance, HR, and business units to advance risk objectives.

Professional Development:

Has a broad range of expertise and understanding of the Company's objectives. Pursues industry certifications, professional development programs, and emerging risk management knowledge to advance expertise.

TRAVEL REQUIREMENTS & WORKING CONDITIONS

Up to 5% travel may be required for broker meetings or site visits. This position operates in a typical hybrid or office environment. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit for extended periods; frequently required to use hands and fingers to operate a computer keyboard, mouse, and other office equipment; and regularly required to talk and hear to communicate with colleagues in person, by phone, and by video conference. The employee is occasionally required to stand and walk. The Associate may occasionally lift and/or move up to 10-15 pounds.

Disclosures

Smoking/vaping and the use of tobacco products are prohibited on all Company premises, including indoor and outdoor areas, parking lots, and Company-owned vehicles. As part of our employment process, candidates who receive a conditional offer may be required to undergo pre-employment drug testing. We are an Equal Opportunity Employer and do not discriminate based on race, color, religion, sex, national origin, age, disability, veteran status, or any other protected status under the law.

Jackson Healthcare

Jackson Healthcare is a family of highly specialized healthcare staffing, search, and technology companies. Our mission is to improve the delivery of patient care and the lives of everyone we touch. This includes the patients, clinicians and healthcare executives we work with through our companies every day, as well as our communities, the nonprofit organizations we support and each associate who is part of our family.