Claims Operations Leader (Remote) Driving Efficiency & Tech

Raphael & Associates; United States; Hybrid; USD 140,000 - 190,000; Full time

Benefits offered by this job

Remote work

Job summary

Raphael & Associates is seeking a Head of Claims Operations to oversee processes, data, and administrative functions across the claims organization. The role partners with Claims leadership, IT, Finance, and Client Services to improve efficiency, implement technology solutions, and ensure teams have the tools to perform effectively.

The position is open to remote or in-office work (Rutherford, NJ). A strong mix of claims experience, operational leadership, and change execution is essential to

Qualifications

• Bachelor's degree or equivalent professional experience required.
• Experience in a TPA, insurance carrier, or independent adjusting organization.
• Proven management or supervisory experience.
• Strong technical aptitude and familiarity with claims systems and reporting tools.
• Ability to translate business needs into system requirements and improvements.
• Experience leading system implementations and technology-enabled initiatives.

Responsibilities

• Oversee day-to-day operations supporting the claims organization.
• Evaluate workflows and standardize processes for efficiency and scalability.
• Identify issues, root causes, and sustainable solutions.
• Partner with leadership to manage workload and priorities.
• Serve as liaison between Claims Operations, IT, and vendors.
• Translate needs into system requirements and specs.
• Support system implementations, enhancements, and upgrades.
• Evaluate automation and AI solutions to boost productivity.
• Communicate changes and ensure adoption by teams.
• Develop and maintain operational reports and KPIs.
• Monitor metrics and identify performance gaps and trends.
• Lead implementations for new clients and programs, define requirements.

Skills

Leadership/management

Analytical skills

Communication

Problem-solving

Organizational skills

Tech aptitude

Collaboration with IT

Education

Bachelor's degree or equivalent professional experience

Tools

Claims systems

Reporting tools

IT/vendor coordination

Job description

Raphael & Associates is seeking a Head of Claims Operations to oversee processes, data, and administrative functions across the claims organization. The role partners with Claims leadership, IT, Finance, and Client Services to improve efficiency, implement technology solutions, and ensure teams have the tools to perform effectively.

The position is open to remote or in-office work (Rutherford, NJ). A strong mix of claims experience, operational leadership, and change execution is essential to