Operations Associate

Piper Companies is seeking an operations Consultant to join an established life insurance company located in Durham, North Carolina. The operations consultant will be responsible for the evaluation, investigation, and resolution of life and annuity claims, perform diverse duties relating to the intake, processing, review, and adjudication of claims, including reviewing for accuracy, file and claim completeness, reviewing coverage and approving payment or denial.

Responsibilities include:

• Evaluate and determine claim coverage for benefits in accordance with policy and/or certificate provisions, and department procedures.
• Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
• Establish claim reserves and authorize payments within authority limits.
• Enter claim payments, reserves, and new claims on various computer programs, inputting concise yet sufficient file documentation.
• Contact and/or interview claimants, doctors, medical specialists, or employers to obtain additional information as needed.
• Manage time adequately to ensure proper turn around for all tasks such as new claims, pending claims, customer service requests, and audit feedback.
• Maintain quality and production standards as defined by procedures and management.
• Communicate with legal counsel on claims requiring litigation.
• Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
• Report overpayments, underpayments, and other irregularities.
• Ability to look at processes and offer suggestions for efficiencies.
• Work with teammates and supervisor to ensure the needs of the claimants are being met.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Maintain complete confidentiality of company business.
• Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies

Qualifications include:

• Must be empathetic while assisting individuals that are facing difficult life experiences.
• Strong organization skills and capacity to recall complex business rules in addition to varied state regulations as they pertain to claims settlements and tax implications.
• Strong communication skills and ability to work with and adjust to all other personality types. Able to handle a multitude of activities moving from one task to the next in a fast, efficient, and accurate manner.
• Detail oriented
• Bachelor's Degree
• Target graduation 2024 – 2026

Compensation includes:

• $20-$23/hour
• Benefits, PTO, holiday, 401k match

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