Director of Claims Operations

Raphael and Associates; Rutherford (NJ); Hybrid; 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 is a globally recognized third-party claims administrator and independent claims adjusting firm, known for delivering exceptional service. We understand the importance of staying agile in a dynamic market and pride ourselves on tailoring our solutions to meet the unique needs of each client. While the work we do as a claims organization is complex, our mission is clear: to deliver outstanding service, attract and retain top-tier professionals, and leverage industry-leading technology to drive results.

Join Our Team

As a leader in the industry, we offer dynamic and rewarding career opportunities for individuals who are driven to make an impact. Our culture is built on collaboration, innovation, and a shared commitment to excellence. We value professionals who bring creativity, vision, and a proactive, results-oriented mindset.

We are seeking experienced, motivated, and forward-thinking individuals to join our team and contribute to our continued success.

The Opportunity

The Head of Claims Operations is a Director-level role responsible for overseeing the processes, systems, data, and administrative functions that support the claims organization. This individual will partner closely with Claims leadership, IT, Finance, Client Services, and other departments to improve operational efficiency, resolve issues, implement technology solutions, and ensure claims teams have the tools and information needed to perform effectively. The ideal candidate combines hands-on claims experience with strong operational leadership, technical aptitude, analytical skills, and a demonstrated ability to improve processes and implement change in a growing organization.

This position is open to remote or in office (Rutherford, NJ)

Key Responsibilities

• Oversee the day-to-day operational functions supporting the claims organization.
• Evaluate claims workflows and identify opportunities to improve efficiency, consistency, accountability, and scalability while establishing and maintaining standardized claims processes, procedures, and operating standards.
• Identify operational issues and drive them through resolution, including determining root causes and implementing sustainable solutions.
• Partner with Claims leadership to address workload, capacity, resource allocation, and operational priorities.
• Serve as the primary liaison between Claims Operations, IT, system vendors, and other technology partners.
• Translate business needs into clear system requirements and functional specifications.
• Support system implementations, enhancements, integrations, testing, and upgrades.
• Evaluate and implement automation and AI-enabled solutions that can improve productivity, accuracy, and the claims process.
• Ensure technology changes are effectively communicated, tested, implemented, and adopted by claims teams.
• Develop and maintain operational reports, dashboards, and key performance indicators.
• Monitor metrics related to productivity, workload, turnaround times, backlogs, capacity, and service levels. Analyze operational data to identify trends, performance gaps, and opportunities for improvement.
• Lead the operational coordination of new client, program, and line-of-business implementations and define operational requirements, workflows, system needs, reporting, and readiness plans for new business.
• C
• oordinate with Claims, IT, Client Services, Finance, and other stakeholders to ensure successful implementation and transition to ongoing operations.
• Identify and address operational gaps or risks during implementation and transition.

Required Qualifications

• Bachelor's degree or equivalent relevant professional experience.
• Experience working for a TPA, insurance carrier, independent adjusting organization, or other claims services organization.
• Management or supervisory experience.
• Strong technical aptitude and experience working with claims systems, reporting tools, IT teams, and/or technology vendors.
• Experience translating business needs into system or reporting requirements.
• Strong analytical skills and experience using data to evaluate performance and support business decisions.
• Experience with system implementations, process improvements, or technology-enabled operational initiatives.
• Ability to manage multiple priorities, projects, and deadlines in a fast-paced environment.
• Strong organizational, communication, problem-solving, and decision-making skills.

Benefits and Perks

We are an organization that values and recognizes the contributions of our team members. We offer a competitive compensation and benefits package commensurate with experience, including base salary, performance-based incentives, paid time off, comprehensive medical, dental, vision, and life insurance, as well as a 401(k) plan with company matching.

Equal Opportunity Employer

Raphael & Associates is an Equal Opportunity Employer. We are committed to building an equitable, collaborative and diverse workforce throughout our organization by providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetic information, veteran status, or any other legally protected characteristic. This policy extends to all aspects of our employment practices, including but not limited to, recruiting, hiring, discipline, terminations, promoting, transferring, compensation, benefits, training, leave of absence, and other terms, conditions, and benefits of employment.

The above is intended to describe this job's general requirements. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.