Risk & Claims Operations Specialist

Overview

Jackson Healthcare and our family of companies provide healthcare systems hospitals and medical facilities of all sizes with the skilled and specialized labor and technologies they need to deliver high quality patient care and achieve the best possible outcomes while connecting healthcare professionals to the temporary engagements contract assignments and permanent placement employment opportunities they desire.

Headquartered in metro Atlanta were powered by more than 2600 associates and over 20000 clinician providers covering all 50 U.S. states.

Our mission is to improve the delivery of patient care and the lives of everyone we touch. This includes the patients clinicians and healthcare executives we work with through our companies every day as well as our communities the nonprofit organizations we support and each associate who is part of our family.

Were always looking to add new talent to our teams. We value diverse professionals at all levels and across multiple disciplines and areas of expertise who have strong leadership skills align with our culture and are committed to excellence.

Position Overview

The Risk & Claims Operations Specialist supports the daily operations of the Risk Management and Claims Management functions across the Jackson Healthcare enterprise. This is not a role for someone who is content with the status quo. We are looking for someone who asks why do we do it this way and then does something about it.

Critically this role operates through influence rather than authority. You will serve as a trusted partner to 22 distinct companies building relationships communicating value and driving process alignment without a direct reporting line. The ability to earn trust communicate clearly and demonstrate consistent value is just as important as technical skill.

The ideal candidate is deadline-driven process-oriented and technologically savvy with the intellectual curiosity to challenge assumptions and the initiative to pursue simpler smarter solutions. Advanced Excel skills a strong sense of ownership and genuine openness to emerging technologies including AI-powered tools like Microsoft Copilot and Claude are essential. If building better processes working across a dynamic enterprise and embracing innovation as a daily practice excites you this role was designed with you in mind.

Risk Review Operations

Jackson Healthcares core business is placing physicians nurses and other healthcare providers in clinical settings across the United States on a short-term basis. Each of the 22 Jackson companies sources and credentials these providers through a rigorous screening process. When a providers background raises a potential concern a licensing issue a gap in history a malpractice flag or other credentialing exception that file is escalated to the Risk team for deeper review. This role is the engine of that process.

• Manage the daily intake and completion of provider Risk Reviews within established deadlines

• Evaluate escalated provider files using Microsoft Teams SharePoint VComm MDStaff and Outlook applying preestablished guidelines and criteria to assess flagged exceptions clinical expertise is not required; sound judgment and process discipline are

• Investigate documentation thoroughly against defined standards identifying and clearly articulating red flags in accordance with established protocols

• Prepare concise well-organized summary reports in Microsoft Word documenting findings and risk considerations

• Assign the appropriate approval level to each provider file based on established criteria

• Record all Risk Review outcomes in the Risk Management Information System (Origami)

• Communicate findings and approval status to company representatives across the Jackson Healthcare family in a clear timely and professional manner

• Conduct annual audits comparing providers paid vs. Risk Reviews completed analyzing year-over-year trends and reporting on gaps or process breakdowns

Claims Verification

Jackson Healthcare manages medical malpractice coverage for providers placed across its 22 companies. When those providers later apply for hospital privileges institutions require a loss history verification confirmation of whether any malpractice claims were filed during the providers time with a Jackson company. Requests flow through an automated portal checked against the claims system handling approximately 12000 verifications annually. The vast majority are processed automatically; when a provider does have a claim on record that exception is routed to this role for review and confirmation before a response is issued.

• Take a leadership role in overseeing the integrity and performance of the automated claims verification process

• Monitor exception queues and manage the review and confirmation of flagged claims before responses are issued

• Maintain organized audit-ready records and ensure process consistency across all verification activity

• Identify opportunities to further strengthen and streamline the verification workflow

Patient Compensation Fund (PCF) Enrollments

In five states healthcare providers are enrolled in a state-sponsored Patient Compensation Fund a specific form of medical malpractice insurance that operates alongside traditional coverage. Each state runs its own enrollment and payment process adding complexity to an already detail-intensive function. This role serves as the coordination hub between three Jackson companies an external enrollment vendor and the applicable insurance entities ensuring enrollments are completed accurately on time and in compliance with each states requirements.

• Coordinate enrollment activity across five states navigating each states distinct process and payment requirements

• Serve as the primary point of contact and communication bridge between Jackson companies the external enrollment vendor and insurance entities

• Track enrollment status manage time-sensitive deadlines and proactively communicate updates to all relevant stakeholders

• Maintain accurate documentation throughout the enrollment lifecycle to support audit readiness and compliance

• As workflows become better understood identify opportunities to streamline coordination reduce friction and improve the overall process this is a function ripe for innovation over time not overnight

Reporting & Presentation

• Prepare monthly PowerPoint presentations summarizing Risk Review status and trends for company leadership

• Build and maintain Excel-based tracking tools including pivot tables charts and VLOOKUPs

• Analyze operational data to surface insights and support informed decision-making across the enterprise

Administrative Functions

• Track contract reviews in Origami and other administrative functions as needed

Education

• Bachelors degree preferred ideally in Risk Management Operations Business or a related field; high school diploma or equivalent required

• 5 - 7 years of experience in process improvement operations management or cross-functional coordination

• Experience in Risk Management Healthcare Operations or Credentialing is a plus but not required

Experience

• Demonstrated experience in process improvement workflow optimization or operational efficiency with a track record of making things work better not just differently

• Experience managing high-volume detail-intensive processes where accuracy and consistency are non-negotiable

• Background in cross-functional collaboration working across teams departments or companies to drive alignment and deliver results through influence

• Experience in reporting data integrity or operations support in a matrixed or multi-entity environment strongly preferred

• Prior experience in Credentialing Risk Management or Claims is helpful but secondary to operational and process credentials

Technical

• Advanced Microsoft Excel (required) pivot tables VLOOKUPs charts and data analysis

• Microsoft 365 Suite Outlook Word PowerPoint Teams SharePoint

• Comfort engaging with multiple platforms and systems; experience with workflow mapping is a plus

• AI & Emerging Technology genuine curiosity and openness to tools such as Microsoft Copilot and Claude; the ability to see and embrace these as productivity enablers rather than disruptions

Professional

• Deadline-driven with a strong sense of ownership and accountability

• Process-oriented thinker who actively questions assumptions and pursues simpler smarter solutions

• Comfortable with ambiguity and energized by change rather than unsettled by it

• Brings a fresh perspective willing to ask is this still the right way and explore alternatives

• Leads through influence able to build trust demonstrate value and drive alignment across organizations without direct authority

• Skilled at navigating a multi-company environment with diverse stakeholders and competing priorities

• Meticulous attention to detail particularly in time-sensitive and compliance-driven environments

• Excellent written and verbal communication skills

• Demonstrated ability to handle sensitive and confidential information with discretion

• Works effectively both independently and collaboratively