Claims Business Process Consultant

Job Summary

A company is looking for a Sr. Claims Business Process Consultant to oversee the Standard Operating Procedure (SOP) team within the Appeals & Grievances function.

Key Responsibilities

• Lead and develop a team of SOP specialists, conducting performance reviews and fostering a culture of accountability
• Oversee the lifecycle of SOPs, ensuring compliance with regulatory standards and collaboration with cross-functional teams
• Contribute to strategic initiatives and process improvements to enhance operational efficiency and reduce cycle times

Required Qualifications

• High School Diploma or GED
• 2+ years of leadership experience in appeals, grievances, or claims operations
• Experience with process mapping and familiarity with JIRA or similar tools
• Solid understanding of SOP development and regulatory compliance
• Familiarity with tools such as ATS, ETS, and Microsoft Copilot/Editor is a plus