AVP of Claims, Fraud & Financial Crimes – Life, Health & Annuities

USAA•San Antonio, NC

2d•Hybrid

About The Position

USAA Life Insurance Company is seeking an executive to lead claims administration and financial crime prevention across its Life, Health, and Annuity businesses. Reporting to the Vice President of LifeCo Operations, the AVP leads Claims and the Special Investigations Unit (SIU), with responsibility for claims administration, complex claim adjudication, fraud prevention and investigation, Anti-Money Laundering (AML), financial crimes, and operational controls. The role oversees claims from routine matters through complex and contestable cases requiring investigation, medical record review, fraud assessment, legal interpretation, and regulatory expertise. The AVP is accountable for ensuring claims are handled promptly, accurately, fairly, and empathetically while meeting regulatory requirements and protecting the organization's financial strength and reputation. The executive develops operating strategies, governance, performance disciplines, and controls; strengthens the relationship between Claims and SIU; and uses data, analytics, technology, and process improvement to improve risk identification, investigative effectiveness, and decision-making. The role partners with Operations, Legal, Compliance, Enterprise Risk, Product Management, and Technology to balance member experience, regulatory obligations, fraud prevention, operational efficiency, and financial stewardship. The position is based in San Antonio, Texas; Charlotte, North Carolina; or Phoenix, Arizona, with an office requirement of four days per week. Relocation assistance is available.

Requirements

Bachelor's degree, or four additional years of related experience beyond the minimum required may be substituted for a degree.
At least 10 years of progressive experience across Life Insurance claims, fraud prevention, financial crimes, risk management, and/or related insurance operations.
At least 6 years of leadership experience building and leading claims, SIU/fraud, financial crimes, risk, compliance, or complex operational teams.
Deep knowledge of Life Insurance, Health Insurance, and/or Annuity claims administration, including the regulatory, operational, and customer considerations of complex claims.
Demonstrated experience managing contestable claims, complex investigations, high-risk settlements, and claims involving potential fraud or material misrepresentation.
Strong knowledge of fraud prevention, investigative practices, AML, financial crimes, operational risk, and related governance and control frameworks.
Ability to improve claims and investigative operations through process improvement, data and analytics, automation, technology, and performance management.
Experience establishing and monitoring performance standards for claims quality, accuracy, cycle time, productivity, customer experience, investigative effectiveness, and financial outcomes.
Experience working with state insurance regulators, auditors, Compliance, Legal, Risk, and other control partners in highly regulated environments.
Ability to balance member advocacy with investigative rigor, regulatory requirements, risk management, and financial stewardship.
Executive presence and ability to influence senior stakeholders and drive complex decisions in a matrixed organization.
Strong analytical, problem-solving, communication, and judgment skills, particularly with complex or sensitive claims and investigations.

Nice To Haves

Deep leadership experience within a prominent Life Insurance organization, with end-to-end accountability for large-scale claims operations and understanding of the policyholder journey and life claims environment.
Broad claims expertise across Life Insurance, Annuities, and/or Health Insurance, including complex and contestable claims, beneficiary disputes, medical record reviews, high-risk settlements, and sensitive member or beneficiary situations.
Leadership of Special Investigations, fraud prevention, and financial crimes capabilities, including strengthening investigation, detection, escalation, and control frameworks.
Success modernizing claims and investigative operations through process redesign, data and analytics, automation, and technology, with measurable improvements to accuracy, cycle times, investigative effectiveness, member experience, and efficiency.
Experience leading large, multi-layered Claims and Special Investigations organizations and developing leaders and a culture balancing member advocacy with investigative rigor and disciplined risk management.
Extensive partnership with Legal, Compliance, Risk, regulators, and other control functions on complex claims, fraud, AML, and financial crime matters with significant regulatory, financial, or reputational implications.

Responsibilities

Lead and continually enhance claims programs, policies, procedures, and operating practices across Life Insurance, Health Insurance, and Annuity products.
Balance member advocacy, regulatory compliance, operational efficiency, and financial stewardship in claims operations.
Oversee investigation, evaluation, adjudication, and resolution of complex, contestable, sensitive, and high-value claims.
Provide leadership and decision authority for high-risk claims and settlements exceeding established authority limits.
Maintain claims governance frameworks, operational controls, quality standards, and consistent decision-making.
Partner with Legal, Medical, Compliance, and Risk stakeholders on claims involving elevated legal, regulatory, financial, or reputational risk.
Review claims trends and operational metrics and identify opportunities to improve outcomes and mitigate risk.
Lead fraud prevention, detection, investigation, and reporting programs for Life Company products and services.
Oversee fraud governance, monitoring, investigative processes, and case management practices.
Develop fraud risk strategies and control frameworks addressing operational, business, and financial risks.
Partner with Enterprise Fraud, Compliance, Legal, and Risk Management to strengthen fraud prevention and regulatory compliance.
Monitor emerging fraud threats, industry trends, and financial crime risks and recommend program improvements.
Lead execution and oversight of Life Company AML programs and related regulatory requirements, including BSA and AML obligations.
Partner with Enterprise Compliance, Legal, and Risk to implement AML policies, standards, and controls.
Support regulatory examinations, audits, reviews, and timely remediation of identified issues.
Identify, assess, monitor, and escalate operational, regulatory, compliance, and reputational risks related to claims and fraud.
Support interactions with state insurance departments, regulatory agencies, external auditors, and internal governance forums.
Use operational metrics, analytics, and performance data to improve claims outcomes, fraud detection, member satisfaction, and efficiency.
Lead continuous improvement initiatives and partner with Technology and Operations on automation, workflow improvements, and other solutions.
Establish and monitor performance indicators for claims and fraud operations.
Lead, coach, develop, and inspire teams; manage performance, career development, workforce planning, succession planning, and employee engagement.
Build organizational capabilities and a culture of accountability, collaboration, operational excellence, and continuous learning.