[Hiring] Director of Claims Operations @Raphael and Associates

Role Description

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.
• Coordinate 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.

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

• Competitive compensation and benefits package commensurate with experience.
• Base salary and performance-based incentives.
• Paid time off.
• Comprehensive medical, dental, vision, and life insurance.
• 401(k) plan with company matching.

Company 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.