Claims Operations Specialist - HYBRID

Claims Operations SpecialistDB Insurance is seeking an experienced, self-starting individual to join our team as a Claims Operations Specialist. As part of our Strategy / Planning team, you will work with various departmental and team leaders to ensure all aspects of our operations fall within both applicable regulatory standards and industry best practices. Your responsibilities and preferred credentials are outlined below.Key Responsibilities:Manage and conduct pre- and post-payment adjudication audits on claim matters to ensure financial, processing, and operational accuracyVerify that claim adjudication aligns with policy terms, standard operating procedures (SOPs), and state or federal regulations.Investigate the underlying causes of errors, overpayments, or underpayments to prevent future recurrenceConduct reviews of existing policies, SOPs, and guidelines to ensure relevance, accuracy, and compliance with current laws and industry standardsProactively propose updates to policies, SOPs, and guidelines based on audit findings and changing legal requirementsHandle claims operational setup and compliance frameworks required for business expansion into new statesAssess claim departmental workflows and results to assist with the development of key performance indicators (KPIs) and evaluation metricsSupport month-end closings and provide statistical data analysisParticipate in, with the potential to oversee, system development, maintenance, and support, while collaborating with and managing external vendorsAd-hoc projects and other responsibilities as assignedQualifications:5–7+ years of progressive experience in property and casualty (P&C) claims, with deep industry knowledge and understandingProven experience in a claims auditing, quality assurance, or compliance-focused role, including experience managing or auditingStrong knowledge of state and federal insurance regulations, Fair Claims Settlement Practices, and compliance requirements (including Medicare Secondary Payer/Section 111 Reporting)Knowledge of operational setup and compliance required for expansion into new jurisdictionsDemonstrated ability to proactively investigate root causes of errors and propose strategic solutions for quality improvementProficiency in financial data analysisExperience collaborating with IT teams and external vendors on system development, maintenance, or process improvementStrong written and verbal communication, organization skills, critical thinking, and analytical capabilitiesBachelor's degree in Business, Finance, Computer Science, Statistics, or a related field is preferredProficiency in SAP, Power BI, SQL, Python, R, Tableau, Excel, and/or data cleaning is preferredProfessional insurance designations (e.g., CPCU, AIC) are highly desirableCertification from the International Compliance Association or another recognized compliance group is a plusBilingual in Korean is a plusBenefitsMedical (PPO), dental (PPO), vision (PPO), and life insurance covered 100% by the company and 50% for dependentsPaid time off and sick leave13 annual paid holidays401(k) plan with up to 4% company matchFlexible Spending Account (FSA) & Dependent Care FSAQuarterly Fringe Benefit reimbursementsJob-related training reimbursementCasual dress codeAbout UsAt DB Insurance USA, we carry forward a legacy of excellence that began in South Korea in 1962 and expanded to the U.S. in 1984. Backed by the financial strength of a global powerhouse (AM Best Rating: A+, S&P Rating: A+), we combine world-class resources with the agility of a close-knit team. With offices in California, Hawaii, New York, and Guam, we provide innovative insurance solutions tailored to protect your property, business, and livelihood. We are committed to fostering a culture of inclusion and innovation, ensuring exceptional service and peace of mind for every policyholder.