Claims Operations Associate responsible for maintaining service standards and managing workflows. Working with Berkshire Hathaway GUARD to provide operational support in claims operations.
Responsibilities
Assist in keeping service standards on track
Ensure regulatory and litigation workflows run smoothly
Equip adjusters and leaders with accurate, timely operational intelligence
Service compliance & QA
Audit callback alerts
Track call answer rates and trends
Maintain and publish the Litigation Calendar for the Complex Unit
Submit external subpoenas via approved vendors; process external subpoena responses
Prepare Utilization Review determination responses and manage medical-records uploads
Build/maintain transfer templates to move files between Complex and Lien units
Draft “no coverage” letters in partnership with the Coverage team
Review Legal Ops invoices for accuracy and policy alignment
Process overflow work: adjuster alerts, ISO activity, FROI filings, and related File reviews
Coordinate review schedules with leaders and insureds
Standardize and collect claim summaries, ensuring completeness ahead of reviews
Flex to support priority initiatives and stakeholders when volume or complexity spikes.
Requirements
Experience in Workers’ Compensation claims operations or shared services
High School Diploma / GED (required)
Familiarity with subpoena workflows, litigation calendars, UR determinations, ISO ClaimSearch, and FROI filings
Strong data skills (Excel/Sheets: formulas, pivot tables; comfort with dashboards/metrics)
Clear, concise writing—especially for coverage letters and executive-facing summaries
High ownership, organization, and follow‑through across multiple teams and deadlines
Proficiency with Microsoft 365 (Outlook, Teams, SharePoint); ability to learn internal systems quickly
Discretion and sound judgment when handling PHI/PII and sensitive claim materials
Nice to have: Exposure to CCU/EIU/Lien unit operations and California claims practices
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