Claims Data Specialist (Remote)

POSITION SUMMARY

The Claims Data Specialist serves as a data steward responsible for ensuring accuracy, consistency, integrity, and compliance of claims data across the organization. This role involves obtaining, analyzing, validating, and maintaining claims data to support regulatory compliance, operational efficiency, and fraud detection. The specialist will play a critical role in data governance initiatives, acting as a bridge between business and IT to uphold enterprise data standards, improve data quality, and enhance decision-making.

PRINCIPAL DUTIES & RESPONSIBILITIES

• Gather, organize, and maintain claims data ensuring accuracy and completeness.
• Examine claims data to identify trends, patterns, and anomalies. Conduct root cause analysis for claim denials, delays, or errors.
• Develop and generate detailed reports and dashboards to communicate findings to management. Provide insights to improve claims processing and accuracy.
• Ensure claims data management complies with relevant regulations and standards.
• Recommend and implement process improvements to streamline claims processing, reduce errors, and enhance efficiency.
• Work with internal stakeholders to resolve issues and improve data handling systems. Act as a subject matter expert on claims data quality and governance. This will include working with enterprise data governance teams to maintain data dictionaries and reference data management (RDM).
• Assist in strategic planning and decision-making by providing actionable insights based on data analysis.
• Perform regular validation and cleansing of data to maintain high quality and reliability.
• Implement source-to-target mappings and lineage for Policy ↔ Claims ↔ Finance flows; maintain SSOT alignment
• Translate data findings into backlog items (process change vs. configuration vs. customization) with value/effort sizing (S/M/L) for prioritization.
• Serve as the data steward for claims data, ensuring adherence to data governance policies, enforcing data quality rules to support Master Data Management (MDM) efforts.
• Maintain detailed documentation of data procedures, analysis methods, and internal controls.
• Adhere to Federal and State laws and regulations.
• Any other duties needed to help fulfill the Association’s Mission, abide by the Association’s Values, and fulfill the Association’s Strategic Objectives.

EDUCATION & EXPERIENCE

• Bachelor’s degree in Data or Business Analytics, Mathematics, or equivalent.
• Experience in the insurance industry preferred.
• Proven experience in data analysis, ideally within homeowners’ insurance.
• Ability to manipulate and analyze data, using reasoning and logic to draw conclusions.
• Experience using SQL and advanced Excel (V-lookups, pivot tables, etc.).
• Knowledge of data governance principles, MDM, RDM, and data lifecycle management.
• BI/Visualization Tools – Power BI or Tableau knowledge is a plus.
• Experience with data governance and quality tools such as MS Purview or Informatica DQ is a plus.
• Excellent internal customer service, as well as strong oral and written communication skills.
• Minimum of three years of relevant work experience.