7+ years of leadership experience managing teams in a claims or benefits environment.
10+ years in Group Benefits Claims, with strong preference for candidates experienced in Stop Loss.
Extensive knowledge of Stop Loss policies, HIPAA, PHI, COBRA, and ACA regulations.
Proven track record of improving departmental workflows and quality measures.
Exceptional communication skills with the ability to foster partnerships across various teams and levels.
Bachelor's degree is strongly preferred.
Strong technical skills, particularly in Microsoft Office and data reporting tools.
Responsibilities
Drive client service excellence and strengthen relationships with key partners and stakeholders.
Set priorities and strategies with senior leadership to enhance growth and service quality in claims operations.
Lead and develop Claims Managers and analysts, focusing on capability-building and performance improvement.
Oversee Claims teams to ensure productivity and compliance with service expectations using metrics and reporting.
Act as a subject matter expert on complex claims and serve as a representative in cross-functional initiatives.
Lead efforts in quality control and compliance to maintain service standards and mitigate risk.
Support evolving business needs with additional duties and projects as required.
Benefits
Flexible work options allowing up to two days of remote work after the initial training period.
Opportunities for professional development and career growth through coaching and training programs.
Engagement in strategic initiatives that influence both personal and organizational performance.
Access to a collaborative environment where communication and cross-team partnerships are valued.
Involvement in operations that impact the larger organization and client satisfaction.
Full Job Description
Director of Claims reports directly to the Vice President of Claims and is responsible for providing operational and strategic leadership to the Amwins Self-Funded Claims Department. This role drives service excellence, staff development, and continuous improvement across assigned Claims divisions. This is an in-office position with the option to work from home up to two days per week after an initial training period.
Responsibilities:
Client & Partner Engagement: Drive exceptional client service and service-level agreement performance while strengthening relationships with internal teams, senior leadership, carriers, brokers, consultants, and administrators. Represent Claims in key forums with clear, actionable updates on performance, initiatives, and industry trends, as requested.
Strategic & Operational Leadership: Partner with senior leadership to set priorities, performance targets, and strategies that advance growth, profitability, service quality, and scalable claims operations. Execute process, policy, and technology improvements that strengthen consistency across the department.
People Leadership & Development: Lead, coach, and develop Claims Managers, Claims Leads, and Analysts to build capability, strengthen performance, and support career growth. Oversee training, performance management, talent decisions, and QA alignment to ensure effective execution.
Operational Oversight & Performance Management: Oversee assigned Claims teams to ensure productivity, quality, inventory, staffing, and service performance meet expectations. Use metrics, reporting, and workload insights to improve efficiency, accuracy, compliance, and client satisfaction.
Subject Matter Expertise (SME) & Department Representation: Serve as a trusted SME on complex claims, emerging regulations, escalations, and department processes. Provide technical guidance and represent Claims in meetings, trainings, and cross-functional initiatives that improve workflows and strengthen best practices.
Quality, Compliance & Continuous Improvement: Lead quality, compliance, and continuous improvement efforts that protect service standards, PHI, and regulatory requirements. Translate performance trends into corrective actions that strengthen consistency, mitigate risk, and improve departmental outcomes.
Other Duties: Support additional duties and projects as business needs evolve.
Qualifications include:
Leadership Experience: 7+ years of progressive responsibility in a leadership role, managing direct and indirect reports, with demonstrated experience coaching and developing managers or large teams required.
Industry Experience: 10+ years of experience in Group Benefits Claims; Stop Loss experience strongly preferred.
Industry Knowledge: Strong understanding of Stop Loss policy terms, claims handling best practices and applicable regulations (e.g., HIPPA, PHI, COBRA, ACA). Proven experience managing complex claims portfolios, including high-dollar reimbursement requests and escalated case reviews, preferred.
Operational & Process Mindset: Experience improving or maintaining departmental workflows, production standards, and quality measures.
Communication & Relationship Building: Strong ability to communicate clearly, collaborate across teams, and build trust with internal and external partners.
Education: Bachelor's degree strongly preferred.
Tech Proficiency: Strong technical aptitude with experience working within all Microsoft Office programs (Excel, Outlook, SharePoint, Teams etc.) and data reporting tools.
The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
