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Claims Operations Specialist Jobs (NOW HIRING)

Crox Consulting Inc

Claims Specialist

Englewood, NJ · On-site

$25/hr

The goal of the Claims Operations Specialist is to support the Product Safety Team by handling Claims with professionalism, care and urgency, making sure claims are reported and being handled in a ...

CareSource

Operations Specialist II

Dayton, OH · On-site +1

$62K - $100K/yr

The Operations Specialist II provides analytical support and leadership for project impacting ... Represent claims on cross-functional project work teams * Submit, monitor and prioritize IT tickets ...

Artius Solutions

Senior Claims Specialist

Orange, CA · On-site

$110K - $130K/yr

Senior Claims Specialist - Medical Malpractice Location: Orange, CA 92859 (Onsite) Employment Type ... Opportunity to mentor and lead within claims operations * Stable and professional work environment

USAA

Manager, Claims Operations (Subrogation)

Tampa, FL · On-site +1

$103K - $197K/yr

The Opportunity We are seeking a Manager, Claims Operations to lead a team of subrogation specialists. This role leads Auto, Property or other Claims subrogation employees who are responsible for ...

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How much do claims operations specialist jobs pay per hour?

As of Jul 27, 2026, the average hourly pay for claims operations specialist in the United States is $23.50, according to ZipRecruiter salary data. Most workers in this role earn between $17.55 and $25.72 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Claims Operations Specialist, and why are they important?

To thrive as a Claims Operations Specialist, you need a solid understanding of insurance claims processes, attention to detail, and often a bachelor's degree in business or a related field. Familiarity with claims management software, document management systems, and sometimes industry certifications like AIC (Associate in Claims) are commonly required. Strong analytical thinking, effective communication, and organizational skills help you excel in managing claims efficiently and resolving issues. These skills are crucial for ensuring accurate claims processing, maintaining compliance, and delivering excellent service to clients and stakeholders.

How does a Claims Operations Specialist typically collaborate with other departments to ensure efficient claims processing?

Claims Operations Specialists frequently work with teams such as underwriting, customer service, and legal to resolve complex claims and ensure compliance with company policies. They serve as a liaison to clarify claim details, share relevant documentation, and streamline communication between departments. This cross-functional collaboration helps reduce delays, improve accuracy, and enhance the overall customer experience. Being proactive and communicative is essential for success in this collaborative environment.

What are Claims Operations Specialists?

Claims Operations Specialists are professionals who manage and process insurance claims within an organization. They are responsible for reviewing claims, verifying documentation, and ensuring that all procedures comply with company policies and regulations. Their work helps ensure that customers' claims are handled efficiently, accurately, and in a timely manner. Additionally, they may communicate with claimants, insurance adjusters, and other stakeholders to resolve issues and provide updates throughout the claims process.
More about Claims Operations Specialist jobs
What job categories do people searching Claims Operations Specialist jobs look for? The top searched job categories for Claims Operations Specialist jobs are:
Claims Operations Specialist jobs near you
Infographic showing various Claims Operations Specialist job openings in the United States as of July 2026, with employment types broken down into 90% Full Time, 8% Part Time, and 2% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution, with an average salary of $48,885 per year, or $23.5 per hour.
Claims Operations Specialist - HYBRID

Claims Operations Specialist - HYBRID

DB Insurance Co., Ltd.

Great Neck, NY • On-site

$70K - $100K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 24 days ago

Job description

Job Title

  • Claims Operations Specialist  

Location

  • 1010 Northern Blvd., Suite 238, Great Neck, NY 11021

Salary

  • $70,000 - $100,000/year

Position Type

  • Full-time
  • Exempt (Salaried)
  • Monday – Friday
  • 9:00 am – 6:00 pm
  • Hybrid after 90 days – 3 days in office/2 days remote

Reports to

  • Senior Claims Manager
Position Overview:

DB Insurance is seeking an experienced, self-starting individual to join our team as a Claims Operations Specialist.. As part of our Strategy / Planning team, you will work with various departmental and team leaders to ensure all aspects of our operations fall within both applicable regulatory standards and industry best practices. Your responsibilities and preferred credentials are outlined below. 

Key Responsibilities:
  • Manage and conduct pre- and post-payment adjudication audits on claim matters to ensure financial, processing, and operational accuracy
  • Verify that claim adjudication aligns with policy terms, standard operating procedures (SOPs), and state or federal regulations.
  • Investigate the underlying causes of errors, overpayments, or underpayments to prevent future recurrence
  • Conduct reviews of existing policies, SOPs, and guidelines to ensure relevance, accuracy, and compliance with current laws and industry standards
  • Proactively propose updates to policies, SOPs, and guidelines based on audit findings and changing legal requirements
  • Handle claims operational setup and compliance frameworks required for business expansion into new states
  • Assess claim departmental workflows and results to assist with the development of key performance indicators (KPIs) and evaluation metrics
  • Support month-end closings and provide statistical data analysis
  • Participate in, with the potential to oversee, system development, maintenance, and support, while collaborating with and managing external vendors
  • Ad-hoc projects and other responsibilities as assigned
Qualifications:
  • 5–7+ years of progressive experience in property and casualty (P&C) claims, with deep industry knowledge and understanding
  • Proven experience in a claims auditing, quality assurance, or compliance-focused role, including experience managing or auditing
  • Strong knowledge of state and federal insurance regulations, Fair Claims Settlement Practices, and compliance requirements (including Medicare Secondary Payer/Section 111 Reporting)
  • Knowledge of operational setup and compliance required for expansion into new jurisdictions
  • Demonstrated ability to proactively investigate root causes of errors and propose strategic solutions for quality improvement
  • Proficiency in financial data analysis
  • Experience collaborating with IT teams and external vendors on system development, maintenance, or process improvement
  • Strong written and verbal communication, organization skills, critical thinking, and analytical capabilities
  • Bachelor’s degree in Business, Finance, Computer Science, Statistics, or a related field is preferred
  • Proficiency in SAP, Power BI, SQL, Python, R, Tableau, Excel, and/or data cleaning is preferred
  • Professional insurance designations (e.g., CPCU, AIC) are highly desirable
  • Certification from the International Compliance Association or another recognized compliance group is a plus
  • Bilingual in Korean is a plus

Benefits

  • Medical (PPO), dental (PPO), vision (PPO), and life insurance covered 100% by the company and 50% for dependents
  • Paid time off and sick leave
  • 13 annual paid holidays
  • 401(k) plan with up to 4% company match
  • Flexible Spending Account (FSA) & Dependent Care FSA
  • Quarterly Fringe Benefit reimbursements
  • Job-related training reimbursement
  • Casual dress code

About Us

At DB Insurance USA, we carry forward a legacy of excellence that began in South Korea in 1962 and expanded to the U.S. in 1984. Backed by the financial strength of a global powerhouse (AM Best Rating: A+, S&P Rating: A+), we combine world-class resources with the agility of a close-knit team. With offices in California, Hawaii, New York, and Guam, we provide innovative insurance solutions tailored to protect your property, business, and livelihood. We are committed to fostering a culture of inclusion and innovation, ensuring exceptional service and peace of mind for every policyholder.

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