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Operations Associate - Claims Specialist

companyAspida Financial Services LLC
locationDurham, NC, USA
PublishedPublished: 6/14/2022
Full Time

Job Description

Description:

Company Description:

Aspida Holdings Ltd., through its subsidiaries (collectively “Aspida”), is focused on providing retirement and reinsurance solutions, having operations in the U.S. and Bermuda with total assets of $5.7 billion as of September 30, 2022. Aspida, through its U.S. platform – Aspida Life Insurance Company – is focused on leveraging technology and agility to help clients achieve – and protect – their dreams. Its Bermuda-based reinsurance platform, Aspida Life Re, is focused on providing efficient and secure life and annuity reinsurance solutions. Aspida seeks to be a trusted partner in its clients’ financial security while driving its growth by doing good for the communities it serves. Aspida is backed by Ares Management Corporation, which, through the Ares Insurance Solutions team, provides dedicated investment management, capital solutions and corporate development support. For more information, please visit aspida.com or follow them on LinkedIn, Facebook.

Who We Are:

Sometimes, a group of people come together and create something amazing. They don’t let egos get in the way. They don’t settle for the status quo, and they don’t complain when things get tough. Instead, they see a common vision for the future and each person makes an unspoken commitment to building that future together. That’s the culture, the moxie, and the story of Aspida.

Our business focuses on annuities and life insurance. At first, it might not sound flashy, but that’s why we’re doing things differently than everyone else in our industry. We’re dedicated to developing data-driven tech solutions, providing amazing customer experiences, and applying an entrepreneurial spirit to everything we do. Our work ethic is built on three main tenets: Get $#!+ Done, Do It with Moxie, and Have Fun. If this sounds like the place for you, read on, and then apply at aspida.com/careers.

What We Are Looking For:

The Claims Specialist will be responsible for the evaluation, investigation, and resolution of life and annuity claims, perform diverse duties relating to the intake, processing, review, and adjudication of claims, including reviewing for accuracy, file and claim completeness, reviewing coverage and approving payment or denial. The ideal candidate must be empathetic while assisting individuals that are facing difficult life experiences. The right person for this role has strong organization skills and capacity to recall complex business rules in addition to varied state regulations as they pertain to claims settlements and tax implications. Individuals must have strong communication skills and ability to work with and adjust to all other personality types. This is a fast-paced team that requires dedicated and prompt team members to ensure nothing sits idle without attention for any span of time. Successful analysts will handle a multitude of activities moving from one task to the next in a fast, efficient, and accurate manner. If you are detail oriented, thrive in a fast-paced environment and are looking to be a part of a world class team, apply now!

What You Will Do:

  • Evaluate and determine claim coverage for benefits in accordance with policy and/or certificate provisions, and department procedures.
  • Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
  • Establish claim reserves and authorize payments within authority limits.
  • Enter claim payments, reserves, and new claims on various computer programs, inputting concise yet sufficient file documentation.
  • Contact and/or interview claimants, doctors, medical specialists, or employers to obtain additional information as needed.
  • Manage time adequately to ensure proper turn around for all tasks such as new claims, pending claims, customer service requests, and audit feedback.
  • Maintain quality and production standards as defined by procedures and management.
  • Communicate with legal counsel on claims requiring litigation.
  • Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
  • Report overpayments, underpayments, and other irregularities.
  • Ability to look at processes and offer suggestions for efficiencies.
  • Work with teammates and supervisor to ensure the needs of the claimants are being met.
  • Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
  • Maintain complete confidentiality of company business.
  • Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
  • Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.

What We Require:

  • One year of claims adjudication or equivalent experience.
  • Must have NC Life License - will allow 90 days to obtain.
  • Complete FMLI Level 1 LOMA course and ACS course within 9 months of employment.
  • Clear and concise verbal and written communication skills.
  • Analytical, problem solving and organizational skills.
  • Attention to Detail and Highly Dependable.
  • Proficiency with MS Office applications, especially Word and Excel.
  • Ability to thrive in a team environment and maintain positive energy in the face of adversity.
  • Demonstrate dependability and reliability.

What We Provide:

  • Hourly
  • Full-Time
  • Flexible/remote work arrangements
  • Responsible Time Off
  • Tuition Reimbursement
  • Full Benefits Package Available

What We Believe:

At Aspida Financial Services, LLC, we are committed to creating a diverse and inclusive environment and are proud to be an equal opportunity employer. As such, Aspida does not and will not discriminate in employment and personnel practices on the basis of race, sex, age, handicap, religion, national origin or any other basis prohibited by applicable law. Hiring, transferring and promotion practices are performed without regard to the above listed items.

Requirements:

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