Claims Director

Acrisure•San Diego, CA

1d•$100,000 - $135,000•Onsite

About The Position

Acrisure is seeking a Claims Director to join our growing SBMA team. SBMA, a third-party administrator, is an affordable ACA-compliant benefits provider to thousands of employers. Their goal is to simplify the complexity of providing employee benefits. SBMA is different because of its personal service, speed of implementation, and innovative approach to benefits coverage. We are seeking an experienced and results-driven Claims Director to lead and oversee our claims operations within a Third-Party Administrator (TPA) environment. This role is responsible for ensuring efficient, compliant, and high-quality claims processing while driving continuous improvement and exceptional client service.

Requirements

Expert-level proficiency in HealthPac.
Strong knowledge of claims compliance, regulatory requirements, and audit standards.
Advanced Excel and reporting skills.
Exceptional attention to detail and organizational abilities.
Excellent communication, problem-solving, and analytical skills.
Ability to handle sensitive information with confidentiality.
Bachelor’s degree in business, Healthcare Administration, Insurance, or a related field.
7+ years of progressive claims management experience, including leadership within a TPA, insurance carrier, or self-insured environment.
Proven ability to lead teams, manage performance metrics, and resolve complex claims or client issues.
Experience with claims systems, reporting tools, and performance dashboards.

Responsibilities

Lead and manage the claims department, including supervisors, claims analysts, and support staff, fostering a culture of accountability, performance, and professional development.
Develop, implement, and continuously refine claims strategies, policies, procedures, and best practices aligned with organizational and client objectives.
Ensure timely, accurate, and fair claims processing in full compliance with applicable federal, state, and contractual regulations.
Monitor, analyze, and report on claims performance metrics, identifying trends, risks, and improvement opportunities.
Ensure adherence to compliance standards, internal controls, and audit requirements, including preparation for and response to internal and external audits.
Handle escalated customer and client issues with professionalism, sound judgment, and a resolution-focused approach.
Collaborate with executive leadership, clients, and operational partners to support business growth and client satisfaction.
Drive operational efficiency, quality improvements, and staff engagement across the department.