Insurance Operations Expert

Skills at this level

FNOL and Claims BDX Processing

— Processes First Notices of Loss with TPAs and reconciles claims bordereaux (BDX), matching loss run fields and resolving discrepancies against source records.

Invoice and LOC Payment Administration

— Administers insurance invoice payments and Letter of Credit (LOC) transactions, and generates loss runs and operational reports on defined cycles.

Information ordering

— Arranges claims files, bordereaux records, and processing steps in a prescribed order or pattern according to intake and documentation rules.

Problem sensitivity

— Recognizes when a claim record, reconciliation, or payment is wrong or likely to go wrong before it becomes an escalation, without necessarily resolving it.

Inductive reasoning

— Combines individual discrepancies, exception patterns, and vendor performance signals into general conclusions about process or data-quality issues.

Business process analysis

— Conducts needs assessments and preliminary cost/benefit analysis to align proposed operational changes across claims, billing, and policy processes.

Regulatory compliance

— Ensures claims, billing, and account operations adhere to applicable insurance industry regulations and internal data-stewardship standards.

SLA management

— Monitors and enforces service level agreement performance of outsourcing vendors and external contractors, tracking deliverables and holding vendors to agreed levels.

KPI monitoring

— Analyzes operational performance metrics — throughput, turnaround, exception rates — to assess effectiveness and identify areas for improvement.

Profitability modeling

— Builds profitability models in Excel to explain and forecast the profitability of new and existing insurance products for operational decisions.

Outsourcing Vendor Oversight

— Leads outsourcing vendor tasks and daily deliverable meetings, sets expectations, answers queries, and coordinates offshore/external operations teams.

Insurance Platform Administration

— Provides systems and operational support for products, processes, and accounts within policy/claims/billing platforms such as Guidewire, Duck Creek, Sapiens, and Applied Epic.

Process Documentation

— Documents operational processes and collaborates with department leads to standardize and implement workflow solutions across insurance lines.

Operations Policy and Standards Setting

— Establishes, communicates, and implements operations-related policies, practices, standards, and security measures across the operations function.

Operations Strategy and Planning

— Develops and implements departmental strategy and business plans and manages the execution of divisional objectives across multiple locations and lines.