Piper Companies is seeking an Operations Specialist to join an established Insurance company located in Durham, North Carolina.  This position is HYBRID and will require you to be onsite Tuesday, Wednesday, and Thursday. The Operations Specialist will evaluate, investigate, and resolve life and annuity claims, ensuring accurate processing while providing empathetic assistance to individuals navigating difficult life events.

Responsibilities of the Operations Specialist:

• Evaluate claim coverage, verify accuracy, and determine settlement outcomes in compliance with policy provisions and state regulations.

• Investigate claims by contacting claimants, medical professionals, or employers to gather required information and documentation.

• Maintain claim files, input payment details, establish reserves, and document case notes accurately in system databases.

• Collaborate with legal counsel on litigated claims and report irregularities such as overpayments or underpayments.

• Adhere to quality, production, and compliance standards while identifying process improvement opportunities.

Qualifications for the Operations Specialist:

• Bachelor’s degree or equivalent experience in claims processing, insurance, or a related field.

• Strong organizational skills with the ability to manage multiple tasks in a fast-paced environment.

• Excellent verbal and written communication skills, with the ability to navigate sensitive conversations empathetically.

• Knowledge of state regulations, business rules, and tax implications related to claims settlements.

• Proficiency in using claims management software and maintaining accurate records.

• Demonstrated ability to work collaboratively within a team and adapt to varying personality types.

• Commitment to compliance with HIPAA and corporate policies, ensuring confidentiality of claimant information.

• Proven problem-solving skills and attention to detail in evaluating and resolving complex claims.

Compensation for the Operations Specialist:

Hourly Rate: $23/ hour

Comprehensive Benefits: Medical, Dental, Vision, 401K, PTO, Sick Leave if required by law, and Holidays

Keywords: Customer Service, HIPPA, CRM, Cross functional collaboration, call center, communication, insurance, claims coverage, reporting, life insurance, annuity claims

This job opens for applications on January 31st, 2025. Applications for this job will be accepted for at least 30 days from the posting date.

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