Sr. Manager, Claims Operations

Coalition, Inc.

2d • $126,000 - $190,000 • Remote

About The Position

Coalition’s Claims team is redefining how policyholders experience claims—combining technical excellence, empathy, and data-driven decision making. The Head of Claims Operations is a strategic leadership role reporting to the Head of Claims, responsible for refining and scaling the operational backbone of our end-to-end claims lifecycle across Cyber and Executive Risk products.
In this role, you will translate a high-level vision into a scalable, high-performing reality—evolving claims operations from a traditional processing function into a strategic center of insight that treats data as an authoritative asset. You will own the frameworks that enable global excellence, including process design, vendor governance, monthly Bordereaux (BDX) reporting, and loss fund oversight, while partnering closely with Finance, Actuarial, Data, Product, Engineering, Legal, Compliance, and Customer Success.
We are seeking an intellectually curious leader who can architect a Gen-AI–enabled future, execute multi-year roadmaps, and develop the digital tools necessary to ensure our claims organization stays at the forefront of the industry’s digital transformation. Success in this role means building a scalable, high-performing operational backbone that improves cycle time, quality, cost efficiency, financial integrity, and policyholder experience across products and geographies.

Requirements

• 10+ years of progressive experience in claims operations, claims shared services, or claims transformation within P&C insurance, specialty lines, or an MGA/TPA environment.
• 5+ years of experience directly managing and scaling teams in a fast-paced environment.
• Experience with modern claims management systems and a track record of leading the efforts to build/optimize proprietary internal tools.
• Demonstrated experience building resilient operational processes and controls, with strong program management and execution skills.
• Experience managing external stakeholders (carriers, TPAs, vendors), including performance governance, issue resolution, and contract/obligation adherence.
• Strong understanding of claims data, financial flows, and reporting expectations (e.g., bordereaux/management information; reserving-related reporting).
• Comfort partnering with technology teams on workflow, automation, systems improvements, and data model changes.
• Excellent written and verbal communication skills; able to translate operational details into clear executive updates and partner communications.
• Experience leading and developing high-performing teams in a fast-paced, evolving environment.
• Operator’s mindset: owns outcomes, builds durable processes, and drives clarity.
• Strong judgment and control orientation; balances speed with risk management.
• Collaborative and service-driven; builds trust across internal and external teams.
• Analytical and data-driven: uses data to identify opportunities for improvement and to prioritize and measure the impact of solutions.
• Comfortable leading change and influencing without direct authority in a complex, matrixed environment.

Nice To Haves

• Experience scaling operations across multiple international jurisdictions and regulatory environments is a plus.

Responsibilities

• Own the claims operating model and day-to-day operational enablement across the lifecycle (FNOL/intake, triage, assignment, adjustments, payments, recoveries, closure, customer-service survey data collection and analysis, and reporting).
• Establish and maintain claims operational policies, procedures, controls, and documentation (SOPs), including clear RACI and escalation paths.
• Identify and execute continuous improvement initiatives to reduce friction, improve quality, and lower operational cost (e.g., automation, standardization, reducing rework, improving vendor workflows).
• Build and maintain service-level objectives (SLOs/SLAs) and operating metrics for internal teams and external partners.
• Establish a framework for systematic/periodic quality checks and validation (data input, documentation, and service).
• Enable increased utilization of technology and automation to support improved service, quality, efficiency, and scalability of the Claims organization.
• Own the overall operational process for the production and transmission of accurate, complete, and timely claims bordereaux (BDX) for carrier partners.
• Serve as the operational point of contact for carrier partner BDX inquiries—coordinating responses, root-cause analysis, corrections, and preventive process improvements.
• Drive continuous improvement in data quality and reporting consistency that strengthens trust with carrier partners and supports reserving and performance insights.
• Lead the establishment and implementation of loss funds in jurisdictions globally, including rollout planning, operational design, and ongoing governance, in collaboration with Finance and Product.
• Oversee claims payment enablement, including invoice processing, reconciliations, and related controls to ensure accuracy, timeliness, and compliance with carrier and regulatory requirements.
• Act as the business owner for claims operations tooling and workflows—partnering with Product and Engineering to enhance systems, automate manual processes, and improve data capture.
• Lead operational readiness for claims handling for new products, jurisdictions, and process changes.
• Elevate claims data into a reliable, decision-driving asset for Finance, Actuarial, and leadership by improving data standards, completeness, and consistency.
• Partner with technology teams to explore and implement Gen-AI and advanced analytics use cases that improve productivity, insight generation, and customer experience.
• Build and maintain operational controls and monitoring to support internal claims audits, carrier partner reviews, and compliance assessments.
• Support the Head of Claims in creating consistent governance across claims, including adherence to claims authority, documentation standards, and reporting controls.
• Ensure claims operations processes meet regulatory requirements and contractual obligations, in partnership with Legal, Compliance, Finance, and Special Projects.
• Maintain audit-ready processes, documentation, and evidence to support internal and external reviews.
• Directly lead, manage, and develop a team of Claims Operations Associates responsible for the organization’s operational backbone.
• Oversee the end-to-end Intake and Triage process—from monitoring FNOL queues to coordinating with forensics vendors and breach counsel—ensuring timely, accurate, and consistent handling.
• Maintain rigorous data quality within the claims management system, including validation of complex policy data and key operational attributes.
• Oversee the loss run process and coordinate carrier partner audits and related action items to ensure continuous alignment and compliance.
• Manage loss fund and payment workflows to ensure accurate invoice processing, reconciliations, and issue resolution.
• Empower the team to serve as subject-matter experts for claims tooling, reporting, and system integrations.
• Maintain high-standard SOPs and leverage operational metrics to feed into a robust quality-assurance and coaching framework.
• Collaborate closely with Finance, Actuarial, Data, Customer Success, Legal, Compliance, Product, and Engineering on strategic initiatives and operational roadmaps.
• Partner with internal stakeholders to ensure seamless readiness and operational support for new products, markets, and distribution arrangements.
• Foster high-impact relationships with key external stakeholders—including carrier partners, TPAs, and panel law firms—to ensure seamless alignment, professional trust, and operational excellence at every touchpoint.

Benefits

• 100% medical, dental and vision coverage
• Flexible PTO policy
• Annual home office stipend and WeWork access
• Mental & physical health wellness programs (One Medical, Headspace, Wellhub, and more)!
• Competitive compensation and opportunity for advancement

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed