IntePros · 2 weeks ago
Claims Operations Specialist
Philadelphia, PA
Full-time
Onsite
Mid Level
$25/hr - $30/hr
4+ years expIntePros is seeking a Claims Operations Specialist who serves as a key liaison between the business and multiple internal departments. This role ensures accurate benefit configuration and timely resolution of benefit-related inquiries, supporting all lines of business and maintaining customer satisfaction.
ConsultingInformation TechnologyStaffing Agency
Hiring Manager
John Wehner
Responsibilities
Act as the primary point of contact for benefit-related tickets submitted by Customer Service, Operations, Claims, Sales, Member Appeals, and Executive teams
Review, triage, and manage incidents across all lines of business and market segments, ensuring resolution within established internal SLAs
Conduct in-depth research across multiple systems to validate client, product, and benefit setup
Utilize core applications such as FOS, CSIW, Health Rules Payor, and Product Configurator to investigate and resolve benefit discrepancies
Analyze benefit rules and configurations to identify root causes and recommend corrective actions
Prepare clear, accurate, and professional written responses with supporting documentation for key, high-visibility, and executive-level inquiries
Facilitate cross-functional discussions to align stakeholders on benefit rules, configuration, and interpretation
Ensure consistent understanding and application of benefit logic across departments
Qualification
Required
Bachelor's degree or equivalent relevant experience
3–5 years of related professional experience
4+ years of health insurance claims processing experience
Strong analytical and problem-solving skills with the ability to interpret complex benefit structures
Proven ability to communicate complex concepts clearly to both technical and non-technical audiences
Proficiency in Microsoft Office applications
Company
IntePros
IntePros is an established, woman-owned, privately-held technology and business services consulting agency committed to building long-term relationships and helping more companies leverage the power of a more diverse workforce.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Loren Kovalcik
CEO
Company data provided by crunchbase