Policy Administrator

Position Summary

The Policy & Data Administration Specialist is responsible for maintaining the accuracy, integrity, and consistency of policy, provider, plan, and claim administration data within NAHGA's systems. This position serves as a critical resource supporting operational excellence through accurate system maintenance, data governance, quality control, and adherence to established procedures.

The Policy & Data Administration Specialist ensures information is entered, maintained, and updated accurately to support efficient claims administration, audit readiness, client requirements, and organizational compliance standards. This role works collaboratively across departments to ensure data accuracy and operational consistency.

Essential Duties and Responsibilities

Policy Administration

• Enter new policies and policy updates into claims administration systems accurately and timely.
• Maintain policy records, including amendments, revisions, renewals, and corrections.
• Review policy setup for completeness and accuracy.
• Update plan notes and policy-related information as requested.

· Research and resolve policy discrepancies by collaborating with internal teams and maintaining professional communication with insurance carriers to ensure accurate policy administration.

System Administration

• Maintain and update tables and other system reference tables.
• Ensure system data remains accurate, complete, and consistent.

Claims Administration Support

• Update and maintain team assignment lists.
• Correct claim case types and classifications.
• Transfer, reassign, and route claims as directed.
• Move claims between cases
• Attach claims to existing cases

Provider Administration

• Add new provider records to the system.
• Update and maintain existing provider information.
• Research and resolve provider data discrepancies.
• Update provider notes as requested.

Compliance & Quality Assurance

• Adhere to established policies, procedures, and internal controls.
• Support audit readiness by maintaining accurate and complete records.
• Assist with internal audits, data reviews, and quality assurance initiatives.
• Monitor data accuracy and identify opportunities for process improvement.

Operational Support

• Respond to internal requests related to policy, provider, and system maintenance.
• Assist with special projects and cross-functional initiatives.
• Develop and maintain procedural documentation and work instructions.
• Provide administrative support for compliance and operational initiatives.
• Perform other duties as assigned.

Qualifications

Education & Experience

• High school diploma or equivalent required.
• Associate degree preferred.
• Experience working within insurance claims administration systems preferred.

Knowledge, Skills & Abilities

• Strong attention to detail and commitment to accuracy.
• Excellent organizational and time management skills.
• Ability to manage multiple priorities and meet deadlines.
• Strong analytical and problem-solving abilities.
• Proficiency with Microsoft Office applications, including Excel.
• Ability to learn and navigate multiple systems and databases.
• Strong written and verbal communication skills.
• Ability to work independently and collaboratively within a team environment.

Core Competencies

• Accountability
• Attention to Detail
• Data Integrity
• Compliance Awareness
• Quality Focus
• Organization
• Collaboration

Join our team as a Policy Administrator if you are passionate about ensuring accuracy in insurance operations while supporting clients through complex claims processes. Your expertise will help uphold our commitment to regulatory compliance while delivering exceptional service in a fast-moving environment.

Pay: $21.00 - $22.00 per hour

Benefits:

• 401(k)
• Flexible spending account
• Health insurance
• Health savings account
• Paid time off
• Vision insurance
• Work from home

Work Location: Hybrid remote in Bridgton, ME 04009

Salary : $21 - $22