Job Description

The Claims Team is responsible for the accurate, timely, and consistent resolution of customer, distributor, and internal claims. This role supports end to end claims processing, including Pricing Claims, FAST Claims, ICP Zone Reconciliations and Distributor to Distributor (D2D) transactions, while serving as a process owner for assigned claim types or workflows. Team members collaborate closely with Customer Service, DC locations, Sales Teams, Distribution, and external partners to ensure accuracy, compliance, and continuous process improvement.

This position requires strong analytical skills, attention to detail, and the ability to balance daily transactional work with process ownership and cross functional support.

Key Responsibilities

Claims Processing

• Review claim documentation for accuracy, completeness, and compliance with established policies and timeframes.
• Support claim review and completeness focusing on the department’s goals for claim closure timing.
• Communicate claim decisions clearly to internal stakeholders, CSRs, and external customers or distributors.
• Partner with Customer Service teams to resolve escalated or complex claim scenarios.
• Support ongoing efforts for improvements and transparency in the claims process.
• Ensure claims and follow-ups are processed accurately and aligned with defined business rules.
• Act as a point of contact for related claim questions, issues, or escalations.
• Be available to positively support projects and initiatives across multi departments.

Process Ownership & Continuous Improvement

• Serve as Process Owner for assigned claim types, queues, or workflows.
• Document and maintain standard work, job aids, and process flows for claims activities.
• Identify process gaps, inefficiencies, or recurring issues and recommend improvements.
• Participate in or lead process improvement initiatives, including system enhancements and digital solutions.

Required Qualifications

• High school diploma or GED.
• Minimum of 2 years’ experience in customer service operations.
• At least 2 years of hands-on experience with Salesforce, SAP, or comparable CRM systems.

Preferred Qualifications

• Experience acting as a process owner or supporting process improvement initiatives.
• Strong analytical and problem solving skills.
• Proficiency in Excel and claims/billing systems.
• High attention to detail and accuracy.
• Ability to manage multiple priorities in a fast paced environment.
• Strong written and verbal communication skills.