Sr Claim System Ops Analyst

Under general supervision provides a variety of critical operational support services to the Claim Department, its business partners and its clients.


* Education equivalent to graduation from college or the equivalent in related work experience.


* Three or more years of experience in BSI Claim Systems/Operations or the equivalent, demonstrating a good knowledge of claim systems and field operations.


* Demonstrates effective customer relations skills.


* Demonstrates sound analytical skills.


* Demonstrates a comprehensive knowledge of claim system functions and the relationship of client information to accurate claim processing and reporting.


* Demonstrate ability to work accurately with attention to detail and customer expectations.


* Demonstrate effective and diplomatic oral and written communications skills

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* As Business Subject Matter Expert, participates in the analysis and evaluation of claim systems, equipment and programs; assists in developing system test criteria and participates in the testing and implementation of new and existing programs and procedures.


* Provides subject matter expertise on various projects that are assigned to Claim Operations for handling to completion.


* Develops and maintains a favorable working relationship with internal and external customers.


* Creates, update and maintain manuals and provides assistance/input for Claim Department Manuals.


* Manages and/or participates in various projects that are assigned to Claim Operations for handling to completion i.e., Take Overs, Reverse Take Overs, Novations/Buybacks.


* Provide backup coverage to others in Claim Operations as needed and/or requested.


* Initiates the Break Payment Process within Focus at the request of the Finance Department.

Sends notification to the field claim offices of the effective date of the break payment as well as when the break payment has been lifted.

Monitors the break payment report as well as maintains a list of clients that are on break payment and the reasons they are on break payment.

Distributes the report monthly.


* Handles all Prefund requests as received from the Finance Department.

Updating the contract number table with Clients Large Check Limits, notifying the claim offices of prefund requests and approval/release of pending payments.

Monitor daily, all payments still pending and follow up with Finance as to the status of outstanding items.

Attends weekly prefund meetings with Manager, claim Exec and Finance.


* Provides second level Help Desk Support for Claim Workstation Application.


* Researches, analyzes and writes business requirements for new system development, or existing system enhancements.


* Develops testing plans and scripts and executes system testing for system changes/enhancements for various claim systems as requested.


* Analysis, research and writes internal operational procedural changes/workflows and requi...