Job Title: Director of Claims Operations
This is an in-office position.
The Director, Claims Operations provides strategic leadership and oversight for claims operations across WoodmenLife, ensuring the timely, accurate, and compliant administration of claims across the product portfolio. This role is accountable for operational performance, regulatory compliance, service excellence, continuous improvement, and the development of a high-performing claims organization while ensuring WoodmenLife fulfills its obligations to claimants, beneficiaries, members, and sales teams.
The Director leads all aspects of claims operations, including claim adjudication, complex claims management, quality assurance, workforce planning, risk management, vendor oversight, and process improvement. This role recruits, develops, coaches, and engages associates, fostering a culture of accountability, collaboration, and continuous learning. Working closely with Underwriting, Legal, Compliance, Technology and other business partners, the Director drives effective claims practices that support organizational objectives, enhance the customer experience, and maintain compliance with applicable laws and regulations.
We are looking for someone to: - Provide strategic leadership and oversight of claims operations, ensuring timely, accurate, consistent, and compliant claims administration.
- Establish operational priorities, service standards, quality expectations, and performance metrics that drive operational performance, customer satisfaction, and continuous improvement.
- Direct claims adjudication activities and provides oversight of complex, contestable, litigated, and other high-risk claims, partnering with Legal and other subject matter experts as needed.
- Review and provides direction on escalated claims and serves as the organization's representative in legal proceedings, depositions, arbitrations, and other claims-related matters when required.
- Lead quality assurance and control programs to ensure compliance with contractual obligations, regulatory requirements, and internal policies.
- Build and develop a high-performing team through effective leadership, coaching, talent development, workforce planning, and succession planning, fostering a culture of accountability, collaboration, and continuous learning.
- Oversee third-party vendors supporting claims operations, establishes performance expectations, monitors service delivery, and addresses operational or service concerns.
- Lead audits, examinations, and regulatory reviews, ensuring timely remediation of findings.
- Maintain expertise in industry trends, emerging risks, regulations, and claims practices, translating changes into operational processes, training, controls, and business practices.
- Partner across the organization to address claims matters, support enterprise initiatives, inform product enhancements, and improve the customer experience.
- Manage department budgeting, operational planning, workload forecasting, resource optimization, and performance reporting to support efficient and effective claims operations.
- Lead process optimization, automation, and continuous improvement efforts to improve scalability, efficiency, and effectiveness of claims operations.
- Build and maintain strong stakeholder relationships while ensuring claims operations deliver responsive, high-quality service to claimants, beneficiaries, members, sales teams, and business partners.
- Use claims analytics and operational data to identify trends, improve outcomes, and support business decisions.
- Establish and maintain claims policies, procedures, governance standards, and internal controls to support consistent, compliant, and effective claims administration.
We need someone who has:- Bachelor's degree required; equivalent combination of education and relevant experience may be considered.
- Minimum of 10 years of progressive claims operations experience, including complex claims.
- Minimum of 7 years of leadership experience with direct responsibility for managing and developing teams.
- Strong knowledge of insurance claims handling, insurance contract provisions, industry practices, compliance expectations, and related claims administration practices.
- Knowledge of life insurance, annuities, settlement options, and related claims administration practices preferred.
- Experience with complex claims investigations, fraud prevention efforts, and risk mitigation strategies preferred.
- Demonstrated ability to develop and execute operational strategies that drive business results.
- Demonstrated ability to develop high-performing teams through effective leadership, coaching, talent development, employee engagement, and succession planning.
- Proven ability to lead complex operations, manage risk, establish effective controls, and achieve business outcomes.
- Strong business and operational acumen, including budgeting, workforce planning, capacity planning, workload forecasting, resource optimization, and vendor management.
- Demonstrated ability to use data, analytics, and key performance indicators (KPIs) to monitor performance, identify trends, and drive operational improvements.
- Experience managing audits, market conduct examinations, regulatory reviews, and claims-related legal matters.
- Experience developing business cases, securing stakeholder support, and leading claims-related projects and initiatives.
- Proven success leading change, process improvement, and technology-enabled business initiatives.
- Strong written and verbal communication and presentation skills, with the ability to communicate effectively with internal and external stakeholders.
- Demonstrated ability to influence outcomes, build relationships, handle conflict, and collaborate effectively across all levels of the organization.
- Strong critical thinking and problem-solving skills.
- Strong commitment to customer satisfaction and continuous improvement of the claims experience.
- Professional insurance industry designation (e.g., FLMI, CLU, ChFC, FALU, AALU, or similar) preferred.
If you're ready to make an impact in your community, we'd love to hear from you. Apply today!WoodmenLife will not sponsor applicants for work visas for this position. Applicants must be currently authorized to work in the United States on a full-time basis.
Please ensure your resume includes your current contact information, including:- Full name
- Phone number
- Email address
- Current city and state of residence
