Director, Claims Management – Excellence

Venbrook

. Set the vision, roadmap, and annual goals for claims optimization .

Posted 10/8/2026full-timeRemote • California • United StatesLead💰 $95,000 - $130,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in claims optimization, process improvement, and technology integration, with a strong focus on operational excellence and compliance with industry standards. Proven ability to lead teams, manage complex claims, and drive performance through data-driven decision-making.

Highest-signal resume keywords

Claims OptimizationProcess ImprovementLean Six SigmaClaims Technology IntegrationLeadership in Claims Operations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims HandlingClaims OperationsQuality Assurance ProgramsKPI FrameworksData AnalysisProcess RedesignOperational ExcellenceBudget ManagementVendor ManagementProduct Development

Soft Skills

Excellent CommunicationChange LeadershipExecutive PresenceInfluencing SkillsTeam Leadership

Tools & Technologies

Power BITableauClaims SystemsAI ToolsRobotic Process AutomationPredictive Analytics

Certifications & Qualifications

CPCUMBAAICARMAIMAISSCLACRM

Industry Keywords

Property and Casualty ClaimsMulti-State Regulatory RequirementsFair Claims PracticesLitigation ManagementClaims Best Practices

Tech Stack

Tools & technologies

PMPRPATableau

About the role

Key responsibilities & impact

Set the vision, roadmap, and annual goals for claims optimization
Map and assess claim workflows from first notice of loss through closure
Identify bottlenecks, handoffs, rework, and leakage and measure their effects
Design future-state workflows, standard operating procedures, authority levels, and best practices across lines of business
Lead process improvement projects using Lean, Six Sigma, or similar methods
Lead the claims team and oversee day-to-day claim handling against quality and production standards
Manage inventory, file assignments, caseloads, service standards, escalations, and reassignment of files
Provide technical direction on complex, high-exposure, or litigated claims
Review and approve reserves, payments, and settlements within authority
Present large-loss and roundtable reviews to clients and carriers
Oversee defense counsel, independent adjusters, experts, and other vendors
Ensure claim handling follows client instructions, fair claims practices rules, and applicable state regulations
Pilot new workflows, tools, and quality standards with the claims team
Build and own the claims technology roadmap
Evaluate and roll out claims systems, workflow tools, insurtech partners, AI, document intake automation, robotic process automation, predictive analytics, and client reporting portals
Act as business owner for system changes, including requirements, prioritization, user acceptance testing, and adoption
Partner with data teams on data quality and models for severity, litigation risk, fraud, and recovery opportunities
Ensure tools meet data privacy, security, and AI governance standards
Build and lead the claims quality assurance program
Prepare for client, carrier, and regulatory audits and lead remediation
Monitor compliance with claims practices, service instructions, reserving guidelines, and authority levels
Convert quality findings into training, process fixes, and system controls
Set and track claims performance indicators and lead monthly operating reviews
Build performance reporting and dashboards for leadership, claims managers, and clients
Benchmark performance against industry standards and client service agreements
Use data to support staffing models, capacity planning, and caseload balance
Partner with sales and business development to design new claims products and services
Assess market need, competitor offerings, pricing inputs, and operating requirements and build business cases
Support client proposals, finalist presentations, and client onboarding
Represent Venbrook’s claims capabilities with clients, carriers, brokers, and in industry settings
Lead, mentor, and develop claims professionals, analysts, and quality assurance specialists
Direct cross-functional project teams and manage performance reviews and performance issues
Lead change management through communication, training, and coaching
Create training programs to strengthen technical skills and spread best practices
Manage project timelines, budgets, and vendor relationships
Collaborate with claims, IT, legal, finance, and client-facing teams
Work with finance on process and technology investment costs and returns
Escalate significant matters to the Head of TPA Claims and executive leadership

Requirements

What you’ll need

Bachelor's degree required
CPCU strongly preferred
MBA or other relevant industry designations, such as AIC, ARM, AIM, AIS, SCLA, or CRM, preferred
10 or more years of property and casualty claims experience across several lines of business, including hands-on claims handling and claims operations
5 or more years of progressive leadership experience in claims operations, including managing claims supervisors and examiners
Experience in operational excellence or process improvement, ideally in a TPA, carrier, or self-insured setting
Record of redesigning claims processes or operating models, with measurable gains in quality, cycle time, cost, or client results
Experience leading technology or process modernization, including claims system implementations, analytics, automation, or AI tools
Experience building quality assurance programs and KPI frameworks, and turning data into decisions
Experience designing or launching new products, services, or service models, and supporting business development and client retention
Deep knowledge of claims best practices, reserving, litigation management, fair claims practices rules, and multi-state regulatory requirements
Lean Six Sigma, project management (PMP), or business intelligence tool experience, such as Power BI or Tableau, is a plus
Strong business sense, including experience with budgets, vendor spend, business cases, and financial reporting
Excellent communication, change leadership, and executive presence, with ability to influence clients, partners, and senior leadership

Benefits

Comp & perks

Reasonable accommodations for qualified individuals with disabilities during the application process and throughout employment
Equal opportunity employment