Independently analyze complex claims application, system, and workflow issues and determine appropriate solutions based on business requirements, claims operations, system functionality, and organizational needs
Serve as a subject matter resource for claims applications and RMIS products, providing guidance to Claims Operations, clients, IT personnel, and other business stakeholders regarding system functionality, workflows, and application capabilities.
Perform initial triage and basic troubleshooting for routine Windows 11 and Microsoft 365 user inquiries submitted to the Service Desk, resolving straightforward issues or routing complex technical matters to senior IT personnel.
Perform basic administrative functions within Microsoft 365 following established standard operating procedures (SOPs) and hands-on team training.
Evaluate claims operational processes and system workflows to identify inefficiencies, recurring issues, and opportunities for system or process improvement.
Exercise independent judgment in assessing application-related issues, determining business impact and priority, and recommending appropriate solutions, enhancements, workarounds, or escalation paths.
Partner with Claims Operations, CSU, development teams, and other stakeholders to analyze business needs and translate operational requirements into functional system requirements and recommended solutions.
Research and analyze complex application issues to distinguish between user workflow concerns, configuration issues, system limitations, data issues, and potential application defects.
Recommend modifications to system configurations, workflows, procedures, and business processes to improve operational efficiency, data integrity, user experience, and claims-processing effectiveness.
Participate in the planning, evaluation, testing, and implementation of new claims applications, system enhancements, releases, and functionality.
Develop testing strategies and business-use scenarios; perform user acceptance testing and evaluate whether system enhancements meet operational and business requirements.
Assess the operational impact of proposed system changes and provide recommendations to management and technical teams regarding implementation, training, workflow, and user-readiness considerations.
Serve as a liaison between Claims Operations and technical teams by independently evaluating business concerns and communicating functional and technical requirements.
Analyze recurring Service Desk trends and application issues, identify root causes, and recommend corrective actions or longer-term solutions.
Determine when application issues require escalation to CSU, development, vendors, or other technical resources and provide analysis and supporting documentation to facilitate resolution.
Develop and maintain application procedures, system documentation, SOPs, workflow guides, training materials, and other resources based on business and system requirements.
Design and deliver training related to claims applications, system enhancements, workflow changes, and new functionality.
Provide consultation and guidance to users regarding effective use of claims applications and recommend solutions when standard processes do not adequately address operational needs.
Participate in cross-functional projects involving claims technology, application enhancements, system implementations, workflow redesign, and process improvement initiatives.
Maintain knowledge of claims operations, insurance industry practices, RMIS functionality, emerging technology, and organizational processes to support informed analysis and recommendations.
Manage assigned projects and complex application-support initiatives with limited supervision, establishing priorities and coordinating with appropriate business and technical stakeholders.
Provide recommendations to management regarding claims application functionality, operational processes, system enhancements, training needs, and opportunities for continuous improvement.
Perform other professional duties and responsibilities consistent with the nature and level of the position as assigned.
Education/Experience: Bachelor’s degree in information systems, computer science, business administration, or a related field preferred. Minimum of two to five years of experience in systems analysis, application support, technical support, software implementation, or a related IT role; or an equivalent combination of education and experience. Experience supporting enterprise applications is preferred. Experience within the insurance, workers’ compensation, or third-party administrator (TPA) industry is preferred.
Strong knowledge of claims operations workflows, terminology, insurance concepts, and claims handling processes.
Hands-on experience in claims operations with the ability to understand and evaluate claim system workflows and user requirements.
Working knowledge of claims management/RMIS applications and the ability to troubleshoot application functionality and workflow issues.
Ability to analyze user-reported issues, identify root causes, and recommend appropriate solutions or process improvements.
Working knowledge of Windows 11, Microsoft applications, and standard desktop computing environments.
General understanding of PC hardware, peripherals, and connectivity sufficient to identify and appropriately escalate hardware-related issues.
Ability to learn new systems, applications, enhancements, and business processes and translate technical information into practical guidance for end users.
Ability to develop clear step-by-step instructions, standard operating procedures (SOPs), training materials, and other system documentation.
Strong analytical, problem-solving, organizational, and critical-thinking skills.
Strong attention to detail with demonstrated ability to maintain accurate ticket notes, system documentation, and issue-resolution records.
Ability to independently prioritize and manage multiple service requests, projects, and competing deadlines.
Strong interpersonal and customer-service skills with the ability to communicate effectively with Claims Operations, IT personnel, management, clients, and other stakeholders.
Excellent verbal and written communication skills, including the ability to explain system functionality and technical concepts to non-technical users.
Ability to exercise independent judgment in evaluating application issues and determining appropriate resolution, escalation, or follow-up.
