Top 4 Claims processing occupations Jobs in Orange, Ca

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Performance Contracting —Anaheim, CA
- $92,108 - $138,161 a year
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claims processing occupations jobs near orange, ca

Claims Applications Support Analyst

TRISTAR RISK MANAGEMENT
Long Beach, CA

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Job Details

Full-time
$60,000 - $80,000 a year
3 days ago

Benefits

Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Referral program

Qualifications

Customer communication

Full Job Description

Please make sure to complete all the questions in the application and continue through to the end in order to sign and submit it

POSITION SUMMARY: The Service Desk Claim Applications Support Analyst provides technical and functional support to TRISTAR's Claims Operations teams and clients, with a primary focus on claims-related applications, including the RMIS suite of products.

The Service Desk Claim Applications Support Analyst is a professional-level position responsible for analyzing claims application functionality, business processes, and system workflows and recommending solutions to support Claims Operations and clients related to issues reported via the IT Service Desk Portal.

The position serves as a functional liaison between Claims Operations and Information Technology and exercises independent judgment in evaluating complex application issues, business requirements, system enhancements, and process-improvement opportunities.

This is a professional-level position requiring hands-on claims operations experience, a strong understanding of claims workflows and terminology, and working knowledge of Windows 11, Microsoft products, and insurance industry practices.

This is a remote position. Occasional travel to TRISTAR office locations may be required to provide system training, implementation support, or other business-related assistance.

DUTIES AND RESPONSIBILITIES:

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:

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.

KNOWLEDGE, SKILLS, AND ABILITIES:

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.

Here are some of the benefits you can enjoy in this role:

Medical, Dental, Vision Insurance.
Life and Disability Insurance.
401(k) Plan
Paid Holidays
Paid Time Off.
Referral bonus.

Mental and Physical Requirements: See separate attachment for a copy of the checklist of mental and physical requirements.

MENTAL AND PHYSICAL REQUIREMENTS

MENTAL EFFORT

a. Reasoning development:

X Follow one- or two-step instructions, routine, repetitive tasks.

X Carry out detailed but uninvolved written or verbal instructions; deal with a few concrete

variables.

X Follow written, verbal, or diagrammatic instructions; several concrete variables.

X Solve practical problems; a variety of variables with limited standardization; interpret instructions.

Logical or scientific thinking to solve problems, several abstract and concrete variables.

Wide range of intellectual and practical problems; comprehend most obscure concepts

b. Mathematical development:

X Simple addition and subtraction; copying figures, counting, and recording.

X Add, subtract, multiply, and divide whole numbers.

X Arithmetic calculations involving fractions, decimals, and percentages.

Arithmetic, algebraic, and geometric calculations.

Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.

Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires a theoretical application.

c. Language development:

X Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.

X Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.

Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.

X Ability to compose original correspondence, follow technical manuals, and have increased contact with people.

Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.

2. PHYSICAL EFFORT

a. Physical activity required to perform the job:

X Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

Light work:

a. Exerting up to 20 pounds of force occasionally

b. Exerting up to 10 pounds frequently

c. Exerting a negligible amount of force constantly to move objects

(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).

Medium work:

a. Exerting up to 50 pounds of force occasionally

b. Exerting up to 20 pounds of force frequently

c. Exerting up to 10 pounds of force constantly to move objects

Heavy work:

a. Exerting up to 100 pounds of force occasionally

b. Exerting up to 50 pounds of force frequently

c. Exerting up to 20 pounds of force constantly to move objects

Very heavy work:

a. Exerting in excess of 100 pounds of force occasionally

b. Exerting in excess of 50 pounds of force constantly to move objects

c. Exerting in excess of 20 pounds of force constantly to move object

Visual requirements necessary to perform the job:

Far vision: clarity of vision at 20 feet or more

X Near vision: clarity of vision at 20 feet or less

Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet

Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are.

Color vision: the ability to identify and distinguish colors.

Field of vision: the ability to observe an area up or down or to the right or left while eyes are fixed on a given point.

2. PHYSICAL EFFORT (cont.)

FREQUENCY

c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):

Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.

Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceed that needed for ordinary locomotion and maintenance of body equilibrium.

X Stooping: Bending body downward and forward by bending the spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.

X Kneeling: Bending legs at the knee to come to rest on the knee or knees.

X Crouching: Bending the body downward and forward by bending the legs and spine.

Crawling: Moving about on hands and knees or hands and feet.

X Reaching: Extending hand(s) and arm(s) in any direction.

X Standing: Particularly for sustained periods of time.

X Walking: Moving about on foot to accomplish tasks, particularly for long distances.

X Pushing: Using the upper extremities to press against something with steady force in order to thrust forward, downward, or outward.

X Pulling: Using upper extremities to extend force in order to drag, haul, or tug objects in a sustained motion.

Foot

Motion: Using feet to push pedals.

X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.

X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.

X Grasping: Applying pressure to an object with the fingers and palm.

X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.

X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication and to make fine discriminations in sound, such as when making fine adjustments on machined parts.

Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.

X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers.

Frequent

3. WORKING CONDITIONS

Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure.

WORKING CONDITION

ENVIRONMENTAL

FACTOR

NATURE/REASON

OF EXPOSURE

FREQUENCY

Dirt/Dust

N/A

Noise

N/A

Temperature extremes

N/A

Dampness

N/A

Vibrations

N/A

Equipment movement hazard

N/A

Chemicals/solvents

N/A

Electrical shock

N/A

Significant work pace/pressure

N/A

Odors/Fumes

N/A

Other (specify):

Signatures:

This job description has been approved by all levels of management:

Human Resources: ____________________Manager/Supervisor: _________________________

The employee signature below constitutes the employee's understanding of the mental and physical requirements, essential functions, and duties of the position.

Employee____________________________ Date___________________

Work Location: In person

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claims processing occupations jobs in orange, ca

Claims Applications Support Analyst

Client Service Administrator

Project Engineer

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