Claim Operations Specialist Jobs (NOW HIRING)

Company Summary

If you are searching for a fulfilling place to develop your career and an opportunity to make a difference in helping others, then keep reading on. Here at AAC, we have a progressive culture; we listen to your ideas, value a work/life balance, invest in education, and we foster trust and respect for all individuals. Our exceptional comp and strong benefits include company matching 401K, medical, dental, vision and life insurance. We are looking for our future leaders, who are not only going to fill the qualifications for this job description, but who are going to exceed expectations. Be a part of a team whose mission is to provide quality, compassionate, and innovative care to adults struggling with addiction and co-occurring mental health disorders. Our purpose and passion are to empower patients, their families, and our communities by helping individuals achieve recovery and optimal wellness of the mind, body, and spirit.

Job Summary:

The Insurance Operations Specialist supports AAC’s insurance and claims operations, including professional liability, general liability, workers’ compensation, employment-related matters, and other insured or potentially insured claims. This position serves as a central point of coordination for claim intake, documentation, reporting, tracking, follow-up, and communication throughout the lifecycle of a claim.

The position is responsible for the day-to-day administrative coordination of AAC’s insurance claims and serves as a central resource for maintaining accurate claim information, driving follow-up, and ensuring matters are appropriately routed and escalated.

The Insurance Operations Specialist works closely with facility leadership, Legal, Human Resources, insurance carriers, third-party administrators (TPAs), brokers, claims adjusters, and outside counsel to ensure claims are reported timely, documentation is complete, significant dates and events are tracked, outstanding requests are actively followed through to completion, and claim information remains accurate and current.

This role requires exceptional organizational skills, attention to detail, persistence, sound judgment, and the ability to proactively manage a high volume of matters with competing priorities while maintaining confidentiality and appropriately escalating significant issues.

Duties, Responsibilities and Core Competencies:

Claims Intake & Administration

• Receive and triage notices of incidents, claims, demands, lawsuits, administrative charges, and other matters that may result in an insurance claim.
• Gather initial incident reports, supporting documentation, correspondence, and other information necessary to establish and maintain complete claim files.
• Enter new claims and maintain accurate and current claim information within applicable claims management and internal tracking systems.
• Review incoming matters, gather potentially applicable insurance information, and coordinate timely reporting and tender to appropriate carriers, TPAs, and brokers, with escalation as needed.
• Maintain organized claim files and ensure appropriate documentation and correspondence are retained throughout the lifecycle of each matter.
• Maintain a centralized tracking mechanism for open claims, significant dates, requested follow-ups, mediations, hearings, settlement payment dates, reporting deadlines, and other key milestones.
• Maintain a regular follow-up cadence on open claims and outstanding requests, including unacknowledged tenders, pending coverage determinations, adjuster assignments, requested documentation, counsel updates, and other unresolved action items. Escalate matters that remain outstanding or require management attention.
• Perform periodic review of open claims to identify stale matters, incomplete records, missing status updates, unresolved action items, and claims that may be appropriate for closure.

Carrier, TPA & Counsel Coordination

• Maintain communication and actively follow up with insurance carriers, TPAs, brokers, adjusters, and outside counsel regarding claim acknowledgments, claim numbers, adjuster assignments, coverage determinations, counsel assignments, claim status, and outstanding requests.
• Coordinate with facility leadership and internal departments to obtain medical records, personnel information, incident documentation, and other materials requested in connection with claims.
• Track outstanding requests for information or documentation and follow through with responsible parties until completed or appropriately escalated.
• Assist with coordination and communication among internal stakeholders and external insurance and legal partners to support timely and effective claim administration.
• Identify matters requiring additional review or escalation and promptly bring significant developments, delays, or unresolved issues to Legal and/or Company leadership.

Claim & Litigation Tracking

• Track service of process, attorney correspondence, administrative filings, mediations, settlements, and other significant claim events, including deadlines and dates communicated by Legal or outside counsel.
• Maintain current records of claim status, reported reserves, legal spend, settlements, and final disposition based on information provided by carriers, TPAs, Legal, Finance, and outside counsel.
• Monitor known deadlines, significant dates, and outstanding action items and proactively communicate with appropriate internal and external stakeholders to ensure timely follow-up.
• Support the tracking and administration of professional liability, general liability, workers’ compensation, employment-related, and other insured or potentially insured matters throughout the claim lifecycle.
• Confirm claim closure and maintain complete final claim records when matters are resolved.

Reporting, Data & Insurance Operations

• Assist with preparation of claim summaries, litigation reports, insurance reports, and other claim-related information requested by Legal, Company leadership, the Board, auditors, or other authorized stakeholders.
• Support insurance and claims information requests related to audits, due diligence, transactions, renewals, and other organizational initiatives.
• Maintain accurate and reliable claims data to support reporting and analysis by Legal, Finance, and Company leadership.
• Assist with reconciliation and validation of claim information across internal tracking systems, carrier and TPA reports, and other insurance records as needed.
• Identify recurring administrative issues, documentation gaps, and process inefficiencies and recommend practical improvements to claim intake, tracking, documentation, and follow-up processes.

Collaboration & Confidentiality

• Partner collaboratively with Legal, Human Resources, facility leadership, Finance, and other corporate departments to support effective insurance and claims administration.
• Maintain confidentiality of sensitive claim, employee, patient, legal, and business information and exercise appropriate discretion when handling privileged or confidential matters.
• Communicate professionally and effectively with stakeholders at all organizational levels and with external insurance and legal partners.
• Demonstrate accountability, responsiveness, persistence, and a service-oriented approach when supporting facilities and corporate departments.

Other

• Other duties as assigned.

Education & Experience:

• High school diploma or equivalent required; associate’s or bachelor’s degree in Business Administration, Insurance, Healthcare Administration, Legal Studies, or a related field preferred. Relevant professional experience may substitute for formal education.
• Minimum of 3 years of experience in claims administration, insurance operations, workers’ compensation administration, insured litigation support, or a related function required.
• Experience communicating and coordinating with insurance carriers, TPAs, brokers, claims adjusters, and/or outside counsel strongly preferred.
• Commercial insurance claims experience, including professional liability, general liability, employment practices, workers’ compensation, or similar claims, preferred.
• Healthcare, behavioral health, or multi-state claims experience is a plus.
• Experience using a claims management system, RMIS, matter-management system, or similar tracking platform preferred.
• Strong proficiency with Microsoft Office and/or Google Workspace and the ability to maintain accurate trackers, reports, electronic files, and claim documentation.

Personal Attributes

• Demonstrates exceptional organizational skills and attention to detail with the ability to manage a high volume of claims, deadlines, follow-ups, and competing priorities.
• Demonstrates initiative and follows through on outstanding matters without requiring significant day-to-day direction.
• Comfortable working with limited supervision in a high-volume environment and persistent in obtaining responses, information, and documentation from multiple stakeholders.
• Understands that sending an initial request does not complete an action item and consistently follows matters through to response, resolution, or appropriate escalation.
• Exercises discretion and sound judgment when managing sensitive, confidential, and potentially privileged information.
• Possesses strong problem-solving skills and the ability to identify missing information, inconsistencies, outstanding requests, known deadlines, and matters requiring escalation.
• Demonstrates the ability to review and understand claim-related documentation, including incident reports, demand letters, legal correspondence, lawsuits, administrative filings, insurance information, and settlement documentation.
• Communicates clearly, professionally, and appropriately with internal stakeholders and external insurance and legal partners.
• Maintains accurate and complete records and consistently documents material claim activity and status updates.
• Demonstrates professionalism, accountability, responsiveness, persistence, and a strong sense of ownership over assigned administrative responsibilities.
• Works effectively in a collaborative environment and is willing to support claims-related projects and responsibilities across Legal, Human Resources, Finance, and other functional areas.

Physical Requirements

AAC is committed to principles of equal opportunities for all employees.  The Company will provide reasonable accommodations that are necessary to comply with State and Federal disability discrimination laws.

• Prolonged sitting at a desk
• Must be able to lift 15 pounds at a time

American Addiction Centers is an equal opportunity employer.  American Addiction Centers prohibit employment practices that discriminate against individuals or groups of employees based on age, color disability, national origin, race, religion, sex, sexual orientation, pregnancy, veteran or military status, genetic information or any other category deemed protected by state and/or federal law.