Claims Operations Expert (Contract)
Role Overview
Design and evaluate structured claims workflows across intake, adjudication, and specialized handling scenarios.
Work on precision-driven assignments requiring consistent, rule-based judgment.
$55 $80/hour | ~20 hours per week | Remote
Key Responsibilities
- Develop claims scenarios covering FNOL intake, triage, and coverage determination
- Build adjudication workflows including reserving, documentation, and claim resolution
- Evaluate outputs for accuracy against defined guidelines and policy language
- Create deterministic rubrics with clear, checkable outcomes
- Review claims artifacts such as adjuster notes, reserve memos, and settlement letters
Core Requirements
- Strong expertise in claims handling, operations, or supervision across relevant lines
- Working knowledge of coverage analysis, reserving practices, or claims workflows
- Ability to interpret and produce claims documentation with precision
- High attention to detail with consistent rule-based decision-making
- Clear, structured written communication with step-by-step reasoning
Additional Strengths
- Adjuster licensure or equivalent professional credentials
- Experience with claims systems or specialized claims handling areas
- Ability to manage complex, multi-step claims scenarios with sustained focus
Applications will be reviewed only via LinkedIn Easy Apply.