Operations Specialist (Insurance Claims)

Location: Fully remote; role location listed as Santa Ana, CA, United States.

Compensation: $25.00–$32.00 per hour.

Company

hirify.global is a professional services and technology firm supporting insurance, financial services, public sector, and other highly regulated clients across the risk and insurance value chain.

What you will do

• Act as an operational point of contact for carriers, underwriters, claim handlers, management, and other program stakeholders.
• Coordinate carrier information, risk codes, policy details, classifications, bordereau data, and documentation required for accurate claim reporting.
• Review incoming claims, obtain missing information, enter and validate claim data, and organize documents in claims management systems.
• Maintain program guidelines, workflows, procedures, reference materials, and reporting requirements.
• Monitor KPI, bordereau, service, and program standards; identify deficiencies and recurring issues and communicate them to management.
• Support audits, file reviews, data validation, process improvements, Medicare eligibility and reporting compliance, OFAC payee checks, and closure of settled claims.

Requirements

• Experience in insurance, claims administration, underwriting support, program operations, or a related field.
• Working knowledge of insurance terminology, policy information, and claims processes.
• Excellent organizational skills with the ability to manage multiple priorities and meet deadlines in a high-volume environment.
• Strong verbal and written communication skills for professional communication with clients, underwriters, claim handlers, and management.
• High attention to detail and commitment to data accuracy and complete documentation.
• Proficiency with claims management systems, Microsoft Office applications, carrier portals, and related business tools.
• Regular and dependable attendance and availability during established work hours are required.

Nice to have

• Experience with delegated authority, third-party administrator, managing general agent, or carrier program business.
• Familiarity with bordereau reporting, KPI monitoring, and insurance data management.
• Experience working directly with underwriting and claims teams.
• Experience supporting specialty insurance programs or transportation and environmental claims operations.

Culture & Benefits

• Fully remote work arrangement.
• Medical, dental, and vision plans, subject to eligibility and applicable requirements.
• 401(k) plan with employer matching.
• Paid time off, paid holidays, life insurance, and short- and long-term disability coverage.
• Paid sick leave, family and parental leave, and other mandated benefits where required by law.
• Inclusive workplace focused on diversity, innovation, professional development, automation, and client service.