Director, Claims Management & Excellence

Venbrook•Remote - California, CA

9d•$95,000 - $130,000

About The Position

Venbrook is seeking a Director, Claims Management & Excellence to lead claim handling and raise the standard for how our TPA claims operation works. Reporting to the Head of TPA Claims, this leader will evaluate claim processes end to end, find where workflow and technology can raise quality and efficiency, own claims quality assurance and performance KPIs, oversee a claims handling team, and help design new claims products we can take to market. The role is both strategic and hands-on. The Director will set the direction for a new way of operating and build the processes, data, and tools behind it. They will also stay close enough to the work to understand a claim file, test a new workflow with the people who use it, and represent the operation with clients, carriers, and leadership. The right candidate is a proven claims leader who has changed how a claims operation runs, not just managed one. They pair deep claims knowledge with sound business sense, a strong analytical mind, and a record of modernizing how work gets done.

Requirements

Bachelor's degree required.
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, plus experience in operational excellence or process improvement, ideally in a TPA, carrier, or self-insured setting.
A 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, such as 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.
Strong business sense, including experience with budgets, vendor spend, business cases, and financial reporting.
Excellent communication, change leadership, and executive presence, with the ability to influence clients, partners, and senior leadership.

Nice To Haves

CPCU strongly preferred.
MBA or other relevant industry designations (such as AIC, ARM, AIM, AIS, SCLA, or CRM) are preferred.
Lean Six Sigma, project management (PMP), or business intelligence tool experience (such as Power BI or Tableau) is a plus.

Responsibilities

Set the vision, roadmap, and annual goals for claims optimization so they support Venbrook's overall claims and business priorities.
Map and assess claim workflows end to end, from first notice of loss through intake, assignment, investigation, reserving, litigation management, recovery, payment, and closure.
Find bottlenecks, handoffs, rework, and leakage, and measure their effect on cycle time, cost, and claim outcomes.
Design future-state workflows, standard operating procedures, authority levels, and best practices across lines of business, including general liability, auto, property, and public entity.
Lead process improvement projects using Lean, Six Sigma, or similar methods, and track the benefits after rollout.
Lead a claims team, including claims supervisors, examiners, and oversee day-to-day claim handling against Venbrook and client quality and production standards.
Manage inventory, file assignments, caseloads, and service standards, including escalation and reassignment of files as needed.
Give technical direction on complex, high-exposure, or litigated claims, including coverage and liability analysis, reserving, resolution strategy, and settlement within assigned authority.
Review and approve reserves, payments, and settlements within authority, and present large-loss and roundtable reviews to clients and carriers.
Oversee defense counsel, independent adjusters, experts, and other vendors, including selection, performance, and cost control.
Make sure claim handling follows client service instructions, fair claims practices rules, and applicable state regulations.
Use the team as a pilot group to test new workflows, tools, and quality standards before rolling them out more widely.
Build and own the claims technology roadmap with the Head of TPA Claims, IT, and corporate operations.
Evaluate, choose, and roll out claims systems, workflow tools, and insurtech partners, including AI, document intake automation, robotic process automation, predictive analytics, and client reporting portals.
Act as business owner for system changes: write requirements, set priorities, run user acceptance testing, and drive adoption.
Partner with data teams on data quality and on models that flag severity, litigation risk, fraud, and recovery opportunities earlier.
Make sure new tools meet Venbrook's data privacy, security, and AI governance standards.
Build and lead the claims quality assurance program, including file review standards, audit sampling, scoring, calibration, and feedback to claims managers and staff.
Prepare the operation for client, carrier, and regulatory audits, and lead remediation when findings arise.
Monitor compliance with fair claims practices rules, client service instructions, reserving guidelines, and authority levels.
Turn quality findings into training, process fixes, and system controls.
Set and track key performance indicators such as cycle time, closure rate, pending inventory and age, caseload, reserve accuracy, indemnity and expense leakage, litigation rate, recovery dollars, contact timeliness, and client satisfaction.
Build reporting and dashboards that give leadership, claims managers, and clients clear, timely views of performance, and lead monthly operating reviews.
Benchmark results against industry standards and client service agreements, and set improvement targets.
Use data to support staffing models, capacity planning, and caseload balance.
Partner with the Head of TPA Claims, sales, and business development to design new claims products and services, such as technology-enabled or tiered service models, analytics and risk insight offerings, and program or captive claims support.
Assess market need, competitor offerings, pricing inputs, and operating requirements for new offerings, and build the business case for leadership.
Support client proposals, finalist presentations, and client onboarding with operating design, KPIs, and technology capabilities.
Represent Venbrook's claims capabilities with clients, carriers, brokers, and in industry settings.
Lead, mentor, and develop claims professionals, analysts, and quality assurance specialists, and direct cross-functional project teams. Set clear expectations, conduct performance reviews, and handle performance issues promptly and fairly.
Lead change management, including communication, training, and coaching, so new ways of working take hold.
Create training programs that strengthen technical skills and spread best practices across claims teams.
Manage project timelines, budgets, and vendor relationships.
Work with claims, IT, legal, finance, and client-facing teams to build optimization into every stage of the claim lifecycle.
Work with finance on the cost and return of process and technology investments.
Escalate significant matters to the Head of TPA Claims and executive leadership with clear, well-supported recommendations.