Job Description

Claims Administrative Specialist

Department: Administration

Employment Type: Permanent - Full Time

Location: Pune

Description

The Claims Administrative Specialist plays a critical role in supporting the workers’ compensation and liability claims lifecycle by performing a wide range of administrative and operational tasks. This position is responsible for document management, records retrieval, forms processing, regulatory reporting support, and workflow coordination to ensure claim files are accurate, complete, and compliant.

The role requires strong attention to detail, the ability to manage high-volume tasks across multiple systems, and effective communication with internal teams and external stakeholders. The Claims Administrative Specialist enhances overall claims efficiency by ensuring timely processing, proper documentation, and consistent administrative support throughout the claim lifecycle.

Key Responsibilities

1. Document Management, File Handling & Legal Support

• Prepare legal and claim-related report packages and electronically compile documents, including excess reporting materials
• Support litigation processes, including defense referrals and document submissions to legal partners
• Compile and organized claim documentation from multiple systems for internal and external requests
• Accurately document completed tasks and updates within multiple claim and document management systems
• Process and resolve returned mail, including re-routing and reissuing correspondence as needed

1. Records & Information Retrieval

• Request, track, and follow up on medical records, police reports, and other external documentation
• Maintain logs and status updates for outstanding records requests to ensure timely receipt

1. Forms, Notices & Correspondence Administration

• Prepare, generate, and distribute state-required forms and standard claim correspondence
• Create and issue benefit notices and required communications in compliance with jurisdictional timelines
• Request and process wage statements, medical authorizations, and acknowledgment letters
• Complete index inquiry forms and other required administrative documentation
• Ensure timely and accurate delivery of outgoing communications to appropriate parties

1. Benefit & Payment Administration Support

• Process claim related payments within the claims system based on adjuster direction
• Set up and manage recurring (auto) payments in accordance with disability durations and medical guidance
• Generate associated benefit notices and ensure proper documentation of payment activity
• Support preparation and distribution of payout and financial reports

1. Compliance

• Prepare regulatory transactions (EDI) based on claim activity
• Monitor submission queues, track filing status and ensure timely and accurate reporting
• Identify and resolve errors or rejections and resubmit corrected transactions

1. Workflow & Task Management

• Manage high-volume administrative tasks across multiple systems and workflows
• Track, prioritize, and complete assigned tasks within established service level agreements (SLAs)
• Navigate and update multiple systems to ensure accurate and timely task completion
• Identify and escalate exceptions, discrepancies, or time-sensitive issues

1. Customer Service & Communication

• Provide timely and professional support to internal teams and external stakeholders
• Communicate clearly and effectively, both verbally and in writing
• Respond to inquiries and follow up on outstanding requests as needed

1. Additional Duties

• Perform other administrative tasks and special projects as assigned to support the claims organization
• Assist in cross-functional support as business needs evolve

Skills, Knowledge and Expertise

• Strong attention to detail and accuracy in administrative and data entry tasks
• Ability to manage multiple priorities in a high-volume, deadline-driven environment
• Experience working with document management systems and claims platforms preferred
• Basic understanding of property and casualty and workers’ compensation processes, forms, and terminology preferred
• Proficiency in Microsoft Office and other business systems
• Excellent written and verbal communication skills
• Strong organizational and problem-solving abilities