Claims Process Specialist

Claims Process Specialist

The Claims Process Specialist is responsible for overseeing and managing the end-to-end claims process for homeowners and commercial property claims. The role involves designing, implementing, monitoring, and continuously improving claims processes to ensure efficiency, effectiveness, and compliance with organizational standards. Key responsibilities include defining process workflows, establishing performance metrics, identifying areas for improvement, and maintaining process documentation. Process Owners also facilitate communication and training related to their processes and may lead initiatives to optimize workflows and implement best practices.

This role will serve as the process steward for Claims and its touchpoints with Policy / Underwriting and Finance, as well as reporting for business stakeholders.

Principal Duties & Responsibilities

• Review, develop, implement, and continuously improve the claims process to ensure efficiency, accuracy, and compliance.
• Recommend, standardize, and implement procedures and workflows related to claims handling.
• Monitor the end-to-end claims process, ensuring timely and accurate claims handling.
• Address problems or bottlenecks within the claims process promptly and effectively.
• Ensure all established claims processes comply with company policies, industry standards, and federal and state regulatory requirements.
• Maintain up-to-date knowledge of relevant laws and regulations affecting claims processing. Aligning with California DOI requirements, retention / legal hold, and audit traceability.
• Champion cross-module coherence (Policy / UW ? Claims ? Finance) and Single Source of Truth (SSOT) alignment for data and definitions.
• Oversee the use and maintenance of claims management systems.
• Identify, recommend, implement, and monitor technological improvements to streamline claims operations.
• Develop and update claims policies, procedures, and guidelines.
• Ensure policies are communicated and, in collaboration with the Quality Assurance team, adhered to across the claims team.
• Prepare and present reports on process performance, issues, and improvement initiatives to management.
• Any other duties needed to help fulfill the Association's Mission, abide by the Association's Values, and fulfill the Association's Strategic Objectives.

Education & Experience