Claims Operations Analyst

This position is based in Tigard, Oregon and is not eligible for remote work from another state.

The Claims Operations Analyst serves a dual role within the Property & Casualty Claims Department. This position combines advanced claims operations analysis with direct management of complex property and casualty claims.

As the analyst, the position supports claims administration by analyzing data, evaluating processes, ensuring regulatory compliance, and implementing system and workflow improvements.

As a consultant the position independently investigates, evaluates, manages, and resolves complex property and casualty claims.

Essential Functions/Major Assignments:

Claims Quality, Compliance, and Risk Management

• Conduct operational and file audits to evaluate compliance with claims handling standards, regulatory requirements, reinsurance reporting obligations, internal procedures, and industry best practices.
• Monitor claims files to ensure timely excess/reinsurance carrier notification and compliance with required coverage documentation.
• Ensure reservation of rights letters are issued and documented when appropriate.
• Review claims for accuracy, completeness, reserve adequacy, coding integrity, and compliance with established standards.
• Monitor and validate data reported through MMSEA and other regulatory reporting systems.
• Analyze reserve trends and provide recommendations regarding reserve adequacy, loss projections, and financial exposure.

Business Analysis and Operational Improvement

• Analyze claims data to identify trends, emerging risks, loss patterns, and opportunities for operational improvement.
• Develop and maintain operational reports, dashboards, performance metrics, and analytical tools to support management decision-making.
• Evaluate workflows, systems, and business processes and recommend improvements to increase efficiency, consistency, and data integrity.
• Identify and support automation opportunities that improve claims operations.
• Document business requirements, workflows, system configurations, and process changes.
• Coordinate testing, validation, and implementation of system enhancements and process improvements.

Claims Investigation and Management

• Independently investigate, evaluate, manage, and resolve complex property and casualty claims from inception through closure.
• Conduct factual and legal investigations to determine coverage, liability, damages, and appropriate claim resolution strategies.
• Establish, monitor, and adjust claim reserves based on ongoing evaluation of exposure.
• Estimate litigation costs and evaluate the financial impact of claims.
• Develop and execute claim strategies that support effective and timely claim resolution.
• Ensure all claim files are properly documented and administered in accordance with departmental standards and applicable regulations.

Litigation and Settlement Management

• Participate in litigation strategy meetings and collaborate with defense counsel regarding claim direction and resolution.
• Negotiate settlements within delegated authority.
• Independently negotiate and authorize settlements up to $100,000.
• Consult with the Claims Manager on settlement authority exceeding delegated limits.
• Coordinate issuance of releases, payments, settlement agreements, and other claim-related documentation.

Loss Coding and Coverage Analysis

• Evaluate and apply appropriate loss coding to accurately reflect claim experience.
• Assist with complex coverage analysis and documentation.
• Ensure claims data accurately supports underwriting, actuarial, and financial reporting needs.

Education, Experience, and Certification/Licensure:

Required

• Associates degree in a related field
• Minimum of ten years of experience in handling the full cycle of insurance claims or ten years of progressively responsible experience in insurance claims, risk management, business analysis or a related field
• Must have current and valid driver's license to be able to drive and visit various member locations.
• OR
• An equivalent combination of education, training, and experience sufficient to successfully perform the essential duties of the job.
• Bachelor's Degree in a related field preferred
• Experience working with claims management systems and reporting tools

Closes for application at noon on August 28 2026.