Claims Operations Leader — Tech-Driven & Remote

Raphael and Associates; United States; Remote; USD 120,000 - 180,000; Full time

Job summary

Raphael & Associates seeks a Head of Claims Operations to oversee processes, systems, data, and admin functions supporting the claims organization. The role partners with Claims leadership, IT, Finance, Client Services, and other departments to improve efficiency and implement technology solutions.

The ideal candidate combines hands-on claims experience with strong operational leadership, technical aptitude, and proven ability to drive process improvements in a growing organization.

Qualifications

• Bachelor's degree or equivalent professional experience.
• Experience in a TPA, insurance carrier, independent adjusting org, or claims services.
• Management or supervisory experience.
• Strong technical aptitude and experience with claims systems and IT teams.

Responsibilities

• Oversee day-to-day operational functions supporting the claims organization.
• Improve workflows and establish standardized processes, procedures, and standards.
• Drive resolution of operational issues and implement sustainable solutions.
• Partner with Claims leadership on workload, capacity, and priorities.
• Lead liaison between Claims Operations, IT, vendors, and technology partners.
• Translate business needs into system requirements and functional specs.
• Support system implementations, enhancements, integrations, testing, and upgrades.
• Evaluate automation and AI-enabled solutions to improve productivity and accuracy.
• Communicate, test, and adopt tech changes within claims teams.
• Develop dashboards and KPIs; monitor productivity and service levels.
• Coordinate with stakeholders for new client/program implementations.

Skills

Operational leadership

Analytical skills

Stakeholder collaboration

Project management

Technical aptitude

Education

Bachelor's degree or equivalent

Tools

Claims systems

Reporting tools

IT collaboration

Vendor management

Job description

Raphael & Associates seeks a Head of Claims Operations to oversee processes, systems, data, and admin functions supporting the claims organization. The role partners with Claims leadership, IT, Finance, Client Services, and other departments to improve efficiency and implement technology solutions.

The ideal candidate combines hands-on claims experience with strong operational leadership, technical aptitude, and proven ability to drive process improvements in a growing organization.