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Claims Administration Analyst
San Rafael, CA / Reno, NV
Job Description
Description
Position at The Pasha Group
Information for California residents about our collection and use of job applicant personal information can be found here: Privacy Practices
Job Summary
The Claims Administration Analyst provides data management, claims analysis, TPA management, and system support for the enterprise Claims team and business units.
Primary Objectives
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
This role requires work that may involve the following environmental conditions:
Travel
Occasional Must be able to travel independently to U.S. locations including Hawaii
Screening Requirements
Background Checks
Must be fully vaccinated against COVID-19, except as prohibited by law.
The information included in this description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive or exhaustive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job.
The Claims Administration Analyst provides data management, claims analysis, TPA management, and system support for the enterprise Claims team and business units.
Primary Objectives
- Research and recommend risk and cost control initiatives based on ongoing statistical analysis.
- Manage and maintain data accuracy, codes, tables, reporting, and data transfer files in Claims Administration systems.
- Communicate effectively with customers, business units, and management teams.
- Provide analysis and guidance to third party administrators (TPA) responsible for adjusting Auto Liability, US Longshore and Harbor Workers and State Workers compensation claims.
- Create, import, and manage claim files related to workers compensation and auto liability claims.
- Perform weekly file imports and development for State and United States Longshore, Harbor (USL&H)
- Perform monthly file imports for Automotive Services internal claims as reported by the business unit.
- Update and maintain Policy tables, Vessel/Voyage tables, Manhour tables, Units table for claim types, and Employee tables as scheduled in the Claims Administration systems.
- Identify and report systems and process issues to claims management team for action.
- Provide guidance on case handling to various TPAs.
- Provide claims analysis, reporting, and related recommendations to the Claims team and business unit management.
- Collaborate with Claims management team, TPAs and business units to monitor workers compensation claims and return to work efforts. Facilitate meetings and ensure timely updates and communications.
- Solicit required information from business units and external parties to facilitate claims analysis.
- Record and maintain claim data in claims systems in an accurate, detailed, and timely fashion.
- Track key performance indicators (KPI) on business unit compliance with supporting documentation fulfillment requirements.
- Coordinate with corporate Finance and Accounting teams to respond to audit requests and maintain integrity between claims and financial reporting systems.
- Develop, manage, and maintain effective relationships with business unit teams, underwriters, Third Party Administrators, and vendors.
- Communicate and coordinate with management and sales teams regarding claims data as needed to support client relationship management.
- Drive implementation and consistent utilization of loss mitigation initiatives and practices.
- Monitor and enforce compliance with company policies, contractual obligations and regulatory requirements.
- Identify and make recommendations for process improvements.
- Create and maintain routine and ad hoc reports and analysis.
- Other duties as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education
- Associate degree in business, accounting, or related field or equivalent combination of education and experience required
- Bachelor's degree preferred
- 3+ years' experience in a related administration management position required
- Demonstrated experience conducting detail analysis using claims or similar data to drive business decision making required
- 2+ years' experience in workers compensation claims and/or auto liability claims and/or related field which would provide direct experience with medical terminology and processes preferred
- Experience with loss/damage claims preferred
- Experience in the cargo transportation industry preferred
- Knowledge and understanding of claims/finance systems and processes.
- Strong understanding and demonstrated proficiency with claims management systems, tables, and reporting.
- Ability to manage ambiguity, work independently, and generate original recommendations.
- Ability to perform basic math calculations including multiplication and percentages.
- Ability to communicate clearly with excellent verbal, written, and listening skills.
- Ability to work as an individual contributor and as a valued participant in a team based environment.
- Demonstrated ability to maintain confidentiality with tact and discretion.
- Excellent customer service skills with the ability to develop effective professional relationships.
- Strong attention to detail with a high degree of accuracy with data entry.
- Ability to maintain a professional demeanor and effectively diffuse difficult situations and client interactions.
- Demonstrated proficiency with Microsoft Office products at the following levels: ? Excel: Intermediate level of skill with PivotTable and formula utilization ? Word, Outlook: Basic level of skill
- Delivers Results Rigorously drives self and others to achieve high levels of individual and organization performance.
- Focuses on the Customer & Market Continuously evaluates what is important to the customer/client and develops products or solutions that exceed expectations.
- Makes Sound Business Decisions Makes timely and well-informed decisions that advance critical priorities, capitalize on new opportunities, and resolve problems.
- Practices our Values Supports and models The Pasha Way; conduct reflects Excellence, Honesty, Integrity, Innovation and Teamwork.
- Engages & Inspires Others Leads with energy, self-confidence and understanding in ways that motivate colleagues to achieve more than they thought possible.
- Time Management
- Drive for Results
- Customer Focus
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Hear and speak with sufficient clarity to understand and engage in telephonic information exchange; hear and understand verbal instructions; give and receive information verbally in person or via communication device - Often
- Walk/travel within office environment, crouch/bend to access floor-level storage - Often
- Use hands/fingers to operate office equipment, type/complete data input, write - Often
- Reach with hands, arms; lift, move and manipulate objects weighing up to 20 pounds - Regularly
- Sight sufficient to read instructions, documents, and screen-based information - Often
- Use hands/fingers to manipulate and file documents, folders, small objects - Regularly
This role requires work that may involve the following environmental conditions:
- Corporate office environment
- A hybrid work environment with a mix of on-site and remote work may be available
Travel
Occasional Must be able to travel independently to U.S. locations including Hawaii
Screening Requirements
Background Checks
Must be fully vaccinated against COVID-19, except as prohibited by law.
The information included in this description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive or exhaustive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job.
The applicable salary range is aligned to one of 5 zones according to a cost of labor index for the geographic location of the role. Starting pay for the successful applicant will depend on a variety of job-related factors, which may include related experience, education and training, location, business needs, or market demands. The expected salary range for this role is set forth below. Ranges may be modified in the future.
Zone 3: Starting rate $62,000; up to $67,000 for highly qualified candidates
Zone 3: Starting rate $62,000; up to $67,000 for highly qualified candidates
The Pasha Group family of companies are EOE/AA Employers - Minority/Female/Veteran/Disabled/and other Protected Categories
The Pasha Group is an Equal Opportunity/Affirmative Action Employer. Minorities/Females/Veterans/Disabled/ and Other Protected Categories are encouraged to apply.
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Associate Degree
Required Experience
3+ years
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