[Hiring] Vice President, Claims Operations @Palomar

Role Description

We are seeking a strategic and hands-on Vice President, Claims Operations to join our specialty property and casualty insurance claims leadership team. This executive will strengthen claims operating discipline by:

• Building key performance indicator driven reporting
• Defining claims analytics requirements
• Leading internal and third-party administrator file review/quality assurance programs

The Vice President will translate operational insight into meaningful process improvement, stronger vendor accountability, and scalable claims excellence, improving:

• Consistency
• Compliance
• Reserving discipline
• Overall claim outcomes

Qualifications

• 10+ years of progressive claims experience, preferably within an insurer overseeing TPAs in Property & Casualty lines. Experience with Specialty lines of business is a plus.
• Bachelor's degree required.
• Strong knowledge of claims processes, regulatory compliance, and industry best practices.
• Deep understanding of claims life cycle, reserving practices, LAE drivers, and claims financial metrics.
• Experience defining analytical requirements for claims-related reports, KPIs and metrics to drive operational performance.
• Experience designing and conducting TPA or claims file reviews, or quality assurance assessments across internal claim teams and/or TPAs.
• Strong analytical skills with the ability to translate data into operational and financial strategy.
• Excellent negotiation, communication, and executive presentation skills.
• Proficiency in claims management systems and data reporting tools.

Requirements

• Drive claims operations performance by governing and benchmarking TPAs, strengthening vendor accountability, and translating analytics into clear operational and financial strategy.
• Build and lead KPI-driven reporting by defining analytical requirements and tracking claims KPIs, dashboards, and metrics to measure effectiveness and drive continuous improvement.
• Partner with TPAs on corrective actions to address performance gaps, emerging trends, and control issues.
• Establish a formal TPA governance and Quality Assurance program including scorecards, performance reviews, operating cadence/escalations, and standardized file review criteria, scoring, and reporting.
• Conduct regular operational reviews with TPAs to evaluate results against service expectations, contractual standards, KPIs, and claim-handling requirements.
• Lead internal and TPA claims file reviews to assess handling quality and discipline, including coverage analysis, investigations, reserving, documentation, litigation and vendor management, and compliance with company standards.

Benefits

• Full Suite of Medical Benefits
• Long Term Financial Incentives – STOCK!
• 401k with 3.5% Automatic Fully Vested Employer Contributions
• Competitive PTO + Holiday Program
• Lifestyle Spending Allowance
• Professional Development Assistance
• Career Exploration Opportunities
• Regular company-wide social events (even virtually!)

Company Description

At Palomar, we are committed to diversity, equality and inclusion in all facets of the organization. We have built an open culture that celebrates the diversity of our workforce, while actively championing equality and inclusion practices that make us a company people want to work with and work for.

We believe that diversity, equality and inclusion yields greater organizational creativity and productivity, which helps us serve our customers and partners more effectively.

Delivering on our diversity commitment returns greater value to our shareholders and ultimately makes a positive impact to the communities in which we do business and to the people who live in them.