Claims Examiner Manager

Nakupuna Consulting is seeking a detail-oriented Claims Examiner Manager to support a federal claims management program by conducting claims intake, investigation, research, documentation, and case administration activities. The ideal candidate possesses strong customer service skills, excellent attention to detail, and the ability to manage multiple cases while maintaining accuracy and compliance with established procedures. Experience in insurance, claims processing, legal support, or quality assurance environments is highly desirable.

The following reflects management's definition of essential functions for this job but does not restrict the tasks that may be assigned. Management may assign additional duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.

Conduct initial intake and review of affirmative claims cases and related documentation.
• Request and obtain police reports, accident reports, medical records, insurance information, and other supporting documentation.
  
  
• Identify potential insurance carriers and gather information necessary to support claim development.
  
  
• Communicate professionally with claimants, insurance representatives, medical providers, attorneys, and government personnel.
  
  
• Perform basic legal and insurance research utilizing available resources such as LexisNexis, Westlaw, and public databases.
  
  
• Research state insurance limits, liability standards, and applicable tort law under the direction of senior claims personnel or attorneys.
  
  
• Draft initial Notices of Claim, standard demand letters, and routine correspondence for supervisory review.
  
  
• Maintain accurate electronic case files within the Affirmative Claims Management Program (ACMP) or similar claims management systems.
  
  
• Enter and validate case information, track deadlines, and ensure required actions are completed within established timeframes.
• Review claims files for completeness, accuracy, and compliance with established procedures.
  
  
• Assist with quality assurance reviews, reporting requirements, and process improvement initiatives.
  
  
• Support claims adjudication activities under the direct supervision of senior claims personnel and attorneys.
• Monthly Status Report (MSR): Due 5th business day of each month. Summary of hours worked, personnel status (e.g., vacancies, on-boarding), training completed, and any outstanding operational issues. Submitted via email to COR.
• Quality Control Plan (QCP): Initial draft due 30 days after award; updated annually. Document detailing how the Contractor will monitor performance, mitigate errors, and ensure HIPAA/CUI compliance. Submitted in MS Word/PDF format to CO & COR.
• Contractor Roster: Due 5th business day of each month (or upon personnel change). A list of all active contractor personnel, their CAC expiration dates, and completion dates for mandatory annual DoD training. Submitted to COR.

Skills/Qualifications:

• Excellent written and verbal communication skills.
• Strong customer service and interpersonal communication skills.
• Excellent written and verbal communication skills.
• Strong organizational skills and attention to detail.
• Ability to manage multiple assignments and deadlines simultaneously.
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook, and Teams).
• Ability to conduct research, gather information, and document findings accurately.
• Ability to work independently and as part of a team.
• Experience working with insurance companies, claims organizations, or legal support environments preferred.
• Quality Assurance (QA) or Quality Control (QC) experience preferred.
• Strong ability to quickly learn new technologies, tools, and processes.
• Ability to work independently and as part of a cross-functional team.

Education/Experience:

• Associate's Degree or Bachelor's Degree preferred.
• Minimum of 5-7 years of professional experience in claims processing, insurance operations, legal support, customer service, case management, or related fields.
• Experience supporting claims investigations, insurance administration, legal research, or case management activities preferred.

Clearance Requirements:

• This position requires the ability to obtain and maintain a Public Trust security clearance.

Work Location: Charleston, SC preferred.

Physical Requirements: The ideal candidate must at a minimum be able to meet the following physical requirements of the job with or without a reasonable accommodation:

• Ability to perform repetitive motions with the hands, wrists, and fingers
• Ability to engage in and follow audible communications in emergency situations
• Ability to sit for prolonged periods at a desk and working on a computer

The Nakupuna Companies use a market-based compensation strategy to ensure that our employees are compensated within applicable market ranges commensurate with multiple factors, including but not limited to the individual's particular combination of education, knowledge, skills, competencies, and experience, as well as contract-specific affordability, organizational requirements, and position location. The projected compensation range for this position is $80,000.00 to $95,000.00 (annualized USD). The salary range displayed represents the typical salary range for this position and is just one component of Nakupuna Companies total compensation package for employees.