Senior Claims Process Improvement Specialist

About this role

Job Type:

Full time   Exempt/Non Exempt:  

Salary Job Description:

  Location Details: Remote

Position Schedule / Shift: Monday – Friday: 8:30 AM EST – 5:00 PM EST

Position Summary: Are you passionate about driving meaningful change and improving how work gets done? As a Senior Claims Process Improvement Specialist, you'll lead high-impact initiatives that transform Claims operations, partner with leaders and cross-functional teams to streamline processes, implement innovative solutions, and deliver measurable business results. This role offers the opportunity to influence strategic decisions, leverage data-driven insights, and help shape the future of the Claims organization through continuous improvement and operational excellence.

Key Responsibilities: • Collaborate with Claim leaders to develop change management and implementation strategies for large scale projects or initiatives

• Conducts need analysis assessments

• Gathers and documents business requirements

• Identifies gaps and operational functions in need of improvement

• Designs and documents process enhancements and recommended workflows

• Executes projects ensuring adherence to corporate and regulatory guidelines

• Analyzes data to determine the root cause of operational inefficiencies

• Participates in cross-functional teams performing cost-benefit analysis and budget implications

• Identifies, analyzes, and recommends innovative approaches to resolve highly complex problems

• Forecasts and communicates project outcomes to Claims leadership

• Documents and maintains process flows and procedures

• Measures and tracks achievement of project objectives and timelines

• Works with technology and functional teams on the implementation of Claims system or solutions

• Leads business readiness activities and organizational change management to ensure end users are prepared for system upgrades, changes or new technology or functional solutions

• Participates in the development of training related to process improvement solutions

Qualifications:

Required

Education: • Bachelor’s degree in related field

• A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members.

Experience: • Minimum of 4 years of claim handling experience

• Experience in process improvement activities including evaluating, analyzing, recommending, documenting, and implementing improvements in processes and procedures

• Organizing, controlling, monitoring, and reporting projects including providing work direction and guidance to vendors or Claims teams

• Analyzing information flow and evaluating the effectiveness and efficiency of systems, solutions, and business strategies

• Conducting cost/benefit analysis

• Planning, organizing, and training others on new applications, processes, or vended solutions

• Implementing and evaluating performance interventions

• Analyzing and documenting workflows

• Project management, including planning and oversight

• Preparing and presenting information to management

Skills and Ability to: • Strategic thinking and addressing complex issues Lead multifunctional project teams, including employees of various levels, including management

• Effectively communicate (both verbally and in writing)

• Analyzing potential new products and vendors

• Developing change management plans and leading business readiness activities

• Researching, analyzing, and presenting industry benchmarks and making recommendations

• Analyzing and defining resource and skill requirements for projects

• Participating in or leading process improvement initiative

• Demonstrated strong problem solving and interpersonal skills

• Demonstrated strong organization and prioritization skills

• Effectively works on concurrent projects

• Setting priorities, multitasking, working under pressure, and adapting to changing demands

• Adapting to and effectively lead change

Preferred

Education: • Project Management Professional certification

Experience in: • Presenting information using tools such as PowerPoint, Tableau or similar

• Creating and utilizing process flowcharts, and gap analysis using VISIO or other comparable tools

• Process improvement strategies and best practices

• Project management in a leadership capacity

Knowledge of: • ACG claims systems

• Project management tools

• Multi-line claims operations exposure

Work Environment: This position is currently able to work remotely from a home office location for day-to-day operations, unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.

Compensation & Benefits Overview: ACG complies with all applicable state and local laws regarding required benefits (including PTO, paid sick leave, etc.). Compensation

A Senior Claims Process Improvement Specialist earns a competitive annual salary of $76,000.00 - $100,000.00, along with the opportunity for an annual company bonus incentive.

Benefits

At ACG, we offer a comprehensive and flexible benefits package designed to support your health, financial well-being, and professional growth.

Health & Wellness • Medical plans with multiple coverage options, including HSA eligibility.

• Prescription drug coverage.

• Dental and vision benefits.

• Employee Assistance Program (confidential support services).

Financial Protection & Insurance • Company-paid basic life insurance.

• Optional supplemental life insurance and dependent coverage.

• Short-term and long-term disability coverage.

• Critical illness, accident, and pet insurance options.

Retirement & Savings

• 401(k) plan to support long-term financial goals. 3% automatic deferral upon eligibility; may contribute 1% to 50% of eligible earnings, either pre or post tax. Company match of 50% paid on employee c

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