Operations Consultant

Piper Companies is seeking an Operations Consultant to join a life insurance company located in Durham, North Carolina through an onsite, permanent position with hybrid schedule flexibility. The Operations Consultant is responsible for evaluating, investigating, and resolving life and annuity claims. This role includes managing a variety of tasks related to the intake, processing, reviewing, and adjudication of claims, ensuring accuracy and completeness of files, verifying coverage, and determining whether to approve or deny payments.

Responsibilities of the Operations Consultant include:

• Evaluate and determine claim eligibility and coverage in accordance with policy provisions, company guidelines, and departmental procedures, ensuring accurate and compliant claim decisions.
• Review and analyze claim information to validate accuracy and completeness; establish appropriate reserves, authorize payments within authority limits, and report any overpayments, underpayments, or irregularities.
• Manage all aspects of claim processing, including system entry of new claims, payments, and reserves; maintain thorough documentation and organized claim files for both routine and complex cases.
• Communicate effectively with claimants, medical providers, employers, legal counsel, and internal stakeholders to gather necessary information, support litigation when required, and ensure timely resolution of claims while meeting quality and production standards.
• Uphold regulatory and corporate compliance standards, including HIPAA and company policies; safeguard confidentiality, identify process improvement opportunities, keep management informed of developments, and support special projects as assigned 

Qualifications for the Operations Consultant include:

• Bachelor’s degree required
• 1+ years of professional work experience in a similar role is preferred
• Strong communication and interpersonal skills; background is customer service is a plus
• Must be comfortable providing assistance over the phone and have proficient technological skills

Compensation/Schedule for the Operations Consultant includes:

• Pay Rate Range: $20-23/hour
• Working Hours: 9:00am-6:00pm EST
• Comprehensive Benefits: Medical, Dental, Vision, 401(k), PTO, Paid Sick Leave as required by law

Keywords: operations consultant, life insurance, direct placement, onsite, permanent, customer service, claim eligibility, claim coverage, policy provisions, company guidelines, compliancy, payment authorization, claim processing, payment processing, HIPAA, confidentiality

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