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Claim Operator Jobs in Washington (NOW HIRING)

MedStar Health

Director Risk Management

Washington, DC · On-site

... implements operating policies and procedures for the MGUH Risk Management Department Reviews ... Ensures thorough timely and ongoing documentation of events and claim activity are entered in CMAPS ...

Dufry

Director Risk Management

Bethesda, MD · On-site

$124K - $155K/yr

... operating practices; collaborates with internal and external resources to develop and implement new safety programs and initiatives company-wide * Facilitates regular claim reviews * Provides ...

Dufry

Director Risk Management

Bethesda, MD · On-site

$124K - $155K/yr

... operating practices; collaborates with internal and external resources to develop and implement new safety programs and initiatives company-wide * Facilitates regular claim reviews * Provides ...

Pae

Paralegal

Washington, DC · On-site

$25.58/hr

... operating procedures and guidelines, performs the following tasks. * Compiles and prepares supporting documentation for use by claim review attorneys in discovery/preparation of claims processing in ...

Amentum

Paralegal

Washington, DC · On-site

$25.58/hr

... operating procedures and guidelines, performs the following tasks. * Compiles and prepares supporting documentation for use by claim review attorneys in discovery/preparation of claims processing in ...

Pae

Paralegal

Washington, DC · On-site

$25.58/hr

... operating procedures and guidelines, performs the following tasks: * Compiles and prepares supporting documentation for use by claim review attorneys in discovery/preparation of claims processing in ...

Amentum

Paralegal

Washington, DC · On-site

$25.58/hr

... operating procedures and guidelines, performs the following tasks: * Compiles and prepares supporting documentation for use by claim review attorneys in discovery/preparation of claims processing in ...

Pae

ParalegaI

Washington, DC · On-site

$25.58/hr

... operating procedures and guidelines, performs the following tasks. * Compiles and prepares supporting documentation for use by claim review attorneys in discovery/preparation of claims processing in ...

Amentum

Paralegal

Washington, DC · On-site

$25.58/hr

... operating procedures and guidelines, performs the following tasks: * Compiles and prepares supporting documentation for use by claim review attorneys in discovery/preparation of claims processing in ...

Pae

Paralegal

Washington, DC · On-site

$25.58/hr

... operating procedures and guidelines, performs the following tasks: * Compiles and prepares supporting documentation for use by claim review attorneys in discovery/preparation of claims processing in ...

Amentum

ParalegaI

Washington, DC · On-site

$25.58/hr

... operating procedures and guidelines, performs the following tasks. * Compiles and prepares supporting documentation for use by claim review attorneys in discovery/preparation of claims processing in ...

Naval Academy Business

Dishwasher #26-045a

Annapolis, MD · On-site

$19.48/hr

Experience in operating, breaking down, and cleaning electrical equipment in a restaurant ... To claim a preference, you must attach the following documents with your employment application and ...

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Claim Operator information

What does a claim operator do?

A Claim Operator is responsible for processing and managing insurance claims. They review claim submissions, verify documentation for accuracy, and determine the validity of claims according to company policies. Claim Operators may also communicate with clients, adjusters, and other stakeholders to gather additional information or resolve issues. Their role helps ensure that claims are handled efficiently and fairly, contributing to customer satisfaction and the integrity of the insurance process.

What are the key skills and qualifications needed to thrive as a claim operator, and why are they important?

To thrive as a Claim Operator, you need strong analytical skills, attention to detail, and a foundational understanding of insurance processes, often supported by a high school diploma or equivalent. Familiarity with claims management software, Microsoft Office Suite, and sometimes industry certifications like AIC (Associate in Claims) are typically required. Excellent communication, organization, and problem-solving abilities help in interacting with clients and resolving claims efficiently. These skills are crucial for accurately processing claims, ensuring customer satisfaction, and maintaining compliance with regulatory standards.

What are some common challenges a claim operator faces in managing insurance claims, and how can they be addressed?

Claim Operators often encounter challenges such as handling a high volume of claims, ensuring accuracy in documentation, and meeting strict deadlines. These challenges can be managed by developing strong organizational skills, utilizing claims management software efficiently, and maintaining clear communication with both clients and team members. Staying updated on regulatory changes and company policies also helps prevent errors and ensures compliance throughout the claims process.

What is the difference between Claim Operator vs Claims Adjuster?

AspectClaim OperatorClaims Adjuster
Required CredentialsHigh school diploma or equivalent; some roles may require insurance licensesHigh school diploma; licensing or certification often required
Work EnvironmentInsurance companies, claims processing centersFieldwork and office settings, inspecting damages
Employer & Industry UsageInsurance companies, third-party administratorsInsurance companies, independent adjusting firms
Common Search & ComparisonClaim OperatorClaims Adjuster

Claim Operators primarily handle the administrative processing of claims within insurance companies, focusing on data entry and documentation. Claims Adjusters, on the other hand, evaluate damages, inspect claims, and determine settlement amounts. While both roles require insurance knowledge and sometimes licensing, Claim Operators focus on processing, whereas Claims Adjusters are more involved in assessment and decision-making.

What are popular job titles related to Claim Operator jobs in Washington?

For Claim Operator jobs in Washington, the most frequently searched job titles are:

What job categories do people searching Claim Operator jobs in Washington look for?

The top searched job categories for Claim Operator jobs in Washington are:

What cities in Washington are hiring for Claim Operator jobs?

Cities in Washington with the most Claim Operator job openings:

Claim Operator jobs near you

Director Risk Management

MedStar Health

Washington, DC • On-site

Full-time

Re-posted 22 days ago

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 240 frontline employees who took The Breakroom Quiz

136th of 898 rated healthcare providers

Job description

About the Job
General Summary of Position
Under the general direction of MedStar Health's System Risk Management Office and the Vice President of Medical Affairs (VPMA) of MedStar Georgetown University Hospital (MGUH) directs designs implements and maintains the MGUH Risk Management Program focusing on clinical risk identification risk prevention and risk control. These functions are performed in accordance with all applicable laws and regulations along with MGUH's and MedStar Health's philosophy policies procedures and standards.
Primary Duties and Responsibilities
  • Develops and designs and upon approval implements and administers MGUH's internal risk management program. Works in conjunction with the MedStar Health AVP Medical Professional Liability and MGUH VPMA to ensure the risk program is in accordance with all federal state and regulatory agency requirements.
  • In accordance with the goals and objectives established by both the hospital and MedStar leadership the Director develops and implements operating policies and procedures for the MGUH Risk Management Department Reviews interdepartmental and hospital-wide policies to ensure consistency.
  • Establishes an effective process to ensure that all unanticipated adverse events with potential serious patient or visitor injury are promptly reported to the MedStar system Risk Management Department the VPMA and the Chief Quality & Patient Safety Officer.
  • Develops and actively participates in an efficient and impactful system for the reporting investigation and ongoing documentation assessment and management of all actual and potential liability risk exposures for the hospital.
  • Works closely with the AVP of Medical Professional Liability in the system Risk Management Department in assessing and evaluating active claims for MGUH.
  • Initiates and participates in the implementation of appropriate programs and strategies to minimize or eliminate risk exposure to the hospital and its associates and physicians.
  • Develops and actively participates in the event review process following an unexpected occurrence in collaboration with MGUH's Center for Patient Safety and the Chief Quality and Safety Officer. This would include discussions of potential disclosure conversations with patients and families Care for the Caregiver on-site inspection interviews with key personnel review of medical records and other relevant documentation. Additionally responsible for the collection and storage of relevant equipment and materials involvement of appropriate system-level resources including System Risk Quality and Safety associates and Human Factors experts.
  • Coordinates with the AVP Medical Professional Liability to begin providing support to the patient and family as well as affected associates. Specifically initiates coordination of any disclosure conversations alongside the AVP Medical Professional Liability and the Chief Quality and Safety Officer.
  • Ensures thorough timely and ongoing documentation of events and claim activity are entered in CMAPS MedStar's Risk Management Department's database. Assists the MedStar AVP MPL in all aspects of the claims management process including gathering of hospital documentation and other information necessary to support the management of a claim or suit. Assist in the collection of information during the defense of a claim. Coordinate discovery requests including depositions and meetings with hospital associates and physicians with defense counsel.
  • In collaboration with the system Risk Management Department and MGUH leadership selects trains and orients other members of the hospital's risk management department. Monitors supervises evaluates performance and initiates or recommends personnel action when appropriate. Fosters and maintains a positive atmosphere within the department to include ongoing communication performance feedback and information exchange.
  • Develops and fosters strong collaborative working relationships with all parts of the hospital in particular Hospital Administration the Physician organization the Nursing Department the Hospital's Quality and Safety program. Serves as a resource to physicians administrators nursing personnel and other departmental personnel regarding risk management and claims management issues.
  • Provides periodic reports to Hospital Leadership and MedStar's Risk Management department regarding all risk management activities at the Hospital. Coordinates and participates in hospital-wide risk management related educational programs aimed at reducing the risk of liability exposure for the Hospital and its associates and physicians.
  • Assumes other duties and responsibilities that are appropriate to the position and area. The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered as all-inclusive.

Minimal Qualifications
Education
  • Bachelor's degree in Risk Management Nursing or related field required
  • Master's degree in Risk Management Nursing or related field preferred
  • Jurisprudence doctorate preferred

Experience
  • 5-7 years of risk management experience in a healthcare environment or related field required
  • 5-7 years of direct clinical experience preferred

Licenses and Certifications
  • RN - Registered Nurse - State Licensure and/or Compact State Licensure if Nurse licensure in the District of Columbia preferred
  • CPHRM - Certified Professional in Healthcare Risk Management preferred

This position has a hiring range of
USD $125,403.00 - USD $219,960.00 /Yr.

What Medstar Health employees say

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Get the full story on Breakroom

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About Medstar Health

Sourced by ZipRecruiter

MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Columbia, MD, US

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