Claims Operations Leader — Remote & Tech-Driven

Raphael and Associates; Rutherford (NJ); On-site; USD 120,000 - 190,000; Full time

Benefits offered by this job

Competitive compensation

Performance incentives

Medical insurance

Dental insurance

Vision insurance

401(k) plan

Job summary

Raphael & Associates, a globally recognized third-party claims administrator, seeks a Head of Claims Operations in Rutherford, NJ with remote options. This Director-level role oversees processes, systems, data, and administration to support the claims organization, partnering with IT, Finance, Client Services and other departments to drive efficiency and change.

The ideal candidate combines hands-on claims experience with strong operational leadership, technical aptitude, and a proven ability to

Qualifications

• Bachelor's degree or equivalent professional experience.
• Experience in a TPA, insurer, or independent adjusting organization.
• Management or supervisory experience.
• Strong technical aptitude with claims systems and reporting tools.
• Ability to translate business needs into system requirements.
• Experience guiding system implementations and process improvements.
• Excellent analytical and decision-making skills.

Responsibilities

• Oversee day-to-day operational functions supporting the claims organization.
• Evaluate workflows to improve efficiency, consistency, and scalability.
• Identify operational issues and drive root-cause resolution.
• Partner with leadership to address workload, capacity, and priorities.
• Serve as liaison between Claims Operations, IT, and vendors.
• Translate business needs into system requirements and specs.
• Support system implementations, enhancements, and upgrades.
• Evaluate automation and AI-enabled solutions to boost productivity.
• Ensure changes are communicated, tested, and adopted.
• Develop and maintain operational reports and KPIs.
• Monitor productivity metrics and trends for improvements.
• Lead coordination of new client/program implementations.
• Coordinate with stakeholders for smooth transitions to operations.
• Identify and address gaps or risks during implementation.

Skills

Analytical skills

Leadership

Project management

Communication

Education

Bachelor's degree or equivalent professional experience

Tools

Claims systems

Reporting tools

IT collaboration

Job description

Raphael & Associates, a globally recognized third-party claims administrator, seeks a Head of Claims Operations in Rutherford, NJ with remote options. This Director-level role oversees processes, systems, data, and administration to support the claims organization, partnering with IT, Finance, Client Services and other departments to drive efficiency and change.

The ideal candidate combines hands-on claims experience with strong operational leadership, technical aptitude, and a proven ability to