Director of Claims Operations

🔥 0 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

⏰ Full Time

🔴 Lead

⚙️ Operations

👻 Ghost score 12%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Raphael & Associates

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1978

🛡️ Insurance

🏢 Enterprise

📋 Compliance

Insurance • Enterprise • Compliance

Raphael & Associates is a Third Party Administrator and Independent Claims Adjusting company internationally recognized for its exceptional service and unsurpassed reputation in nationwide claims handling. With a strong focus on property and casualty claims, the company provides comprehensive claims management, field adjusting, and loss control services tailored to meet the needs of various clients, including self-insured and public entities. Through strategic partnerships and regional offices across the country, Raphael & Associates is dedicated to maintaining high standards of service and leveraging technology to improve the claims process.

📋 Description

• Oversee the day-to-day operational functions supporting the claims organization • Evaluate claims workflows and identify opportunities to improve efficiency, consistency, accountability, and scalability • Establish and maintain standardized claims processes, procedures, and operating standards • Identify operational issues, determine root causes, and implement sustainable solutions • Partner with Claims leadership on workload, capacity, resource allocation, and operational priorities • Serve as primary liaison between Claims Operations, IT, system vendors, and other technology partners • Translate business needs into system requirements and functional specifications • Support system implementations, enhancements, integrations, testing, and upgrades • Evaluate and implement automation and AI-enabled solutions • Communicate, test, implement, and drive adoption of technology changes • Develop and maintain operational reports, dashboards, and key performance indicators • Monitor productivity, workload, turnaround times, backlogs, capacity, and service-level metrics • Analyze operational data to identify trends, performance gaps, and improvement opportunities • Lead operational coordination of new client, program, and line-of-business implementations • Define operational requirements, workflows, system needs, reporting, and readiness plans for new business • Coordinate with Claims, IT, Client Services, Finance, and other stakeholders to ensure successful implementation and transition to ongoing operations • Identify and address operational gaps or risks during implementation and transition

🎯 Requirements

• Bachelor's degree or equivalent relevant professional experience • Experience working for a TPA, insurance carrier, independent adjusting organization, or other claims services organization • Management or supervisory experience • Strong technical aptitude and experience working with claims systems, reporting tools, IT teams, and/or technology vendors • Experience translating business needs into system or reporting requirements • Strong analytical skills and experience using data to evaluate performance and support business decisions • Experience with system implementations, process improvements, or technology-enabled operational initiatives • Ability to manage multiple priorities, projects, and deadlines in a fast-paced environment • Strong organizational, communication, problem-solving, and decision-making skills

🏖️ Benefits

• Excellent Salary • Multiple Bonus Opportunities • Medical Benefits including Dental, Vision and Life • Paid Holidays/Vacation • 401(k) Plan • Flex-Time • Educational Assistance Program • Base salary • Performance-based incentives • Paid time off • Comprehensive medical, dental, vision, and life insurance • 401(k) plan with company matching

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