Director, Claims Management – Excellence

This is a fully remote position, open to applicants in California.

📋 Description

• Establish the vision, roadmap, and yearly objectives for claims optimization.

• Analyze and evaluate claim workflows from initial notice of loss to closure.

• Detect bottlenecks, handoffs, rework, and leakage, and assess their impacts.

• Create future-state workflows, standard operating procedures, authority levels, and best practices across various lines of business.

• Drive process improvement initiatives utilizing Lean, Six Sigma, or comparable methodologies.

• Supervise the claims team and manage daily claim handling in accordance with quality and production benchmarks.

• Oversee inventory, file assignments, caseloads, service standards, escalations, and file reassignments.

• Offer technical guidance on complex, high-exposure, or litigated claims.

• Review and authorize reserves, payments, and settlements within designated authority.

• Deliver presentations on large-loss and roundtable reviews to clients and carriers.

• Manage defense counsel, independent adjusters, experts, and other vendors.

• Ensure compliance with client instructions, fair claims practices, and relevant state regulations in claim handling.

• Pilot new workflows, tools, and quality standards with the claims team.

• Develop and maintain the claims technology roadmap.

• Evaluate and implement claims systems, workflow tools, insurtech partnerships, AI, document intake automation, robotic process automation, predictive analytics, and client reporting portals.

• Serve as the business owner for system modifications, including requirements gathering, prioritization, user acceptance testing, and implementation.

• Collaborate with data teams to enhance data quality and models for severity, litigation risk, fraud, and recovery opportunities.

• Ensure tools comply with data privacy, security, and AI governance standards.

• Establish and manage the claims quality assurance program.

• Prepare for client, carrier, and regulatory audits and lead remediation efforts.

• Monitor adherence to claims practices, service instructions, reserving guidelines, and authority levels.

• Translate quality findings into training, process improvements, and system controls.

• Define and monitor claims performance indicators and lead monthly operational reviews.

• Develop performance reporting and dashboards for leadership, claims managers, and clients.

• Compare performance against industry benchmarks and client service agreements.

• Utilize data to inform staffing models, capacity planning, and caseload distribution.

• Collaborate with sales and business development to create innovative claims products and services.

• Evaluate market demand, competitive offerings, pricing factors, and operational requirements to build compelling business cases.

• Assist in client proposals, finalist presentations, and client onboarding processes.

• Represent Venbrook’s claims expertise to clients, carriers, brokers, and in industry forums.

• Lead, mentor, and develop claims professionals, analysts, and quality assurance specialists.

• Direct cross-functional project teams while managing performance reviews and addressing performance issues.

• Lead change management initiatives through effective communication, training, and coaching.

• Create training programs to enhance technical skills and disseminate best practices.

• Oversee project timelines, budgets, and vendor relationships.

• Collaborate with claims, IT, legal, finance, and client-facing teams.

• Work with finance to analyze process and technology investment costs and returns.

• Escalate significant issues to the Head of TPA Claims and executive leadership.

⛳️ Requirements

• A Bachelor's degree is required.

• CPCU designation is strongly preferred.

• An MBA or other relevant industry certifications, such as AIC, ARM, AIM, AIS, SCLA, or CRM, is preferred.

• A minimum of 10 years of experience in property and casualty claims across various lines of business, including hands-on claims handling and operations.

• At least 5 years of progressive leadership experience in claims operations, including overseeing claims supervisors and examiners.

• Experience in operational excellence or process improvement, ideally within a TPA, carrier, or self-insured environment.

• Proven track record in redesigning claims processes or operating models, achieving measurable improvements in quality, cycle time, cost, or client outcomes.

• Experience in leading technology or process modernization efforts, including claims system implementations, analytics, automation, or AI tools.

• Experience in developing quality assurance programs and KPI frameworks, and utilizing data to inform decision-making.

• Experience in designing or launching new products, services, or service models while supporting business development and client retention.

• In-depth understanding of claims best practices, reserving, litigation management, fair claims practices, and multi-state regulatory requirements.

• Familiarity with Lean Six Sigma, project management (PMP), or business intelligence tools such as Power BI or Tableau is a plus.

• Strong business acumen, including experience with budgets, vendor expenditures, business cases, and financial reporting.

• Exceptional communication, change leadership, and executive presence, with the ability to influence clients, partners, and senior leadership.

🏝️ Benefits

• Reasonable accommodations for qualified individuals with disabilities during the application process and throughout employment.

• Equal opportunity employment.