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Director Of Claims Jobs (NOW HIRING)

ClaimSorted Inc

Head of Claims

New York, NY · On-site

$180K - $250K/yr

  • Medical

  • Retirement

  • PTO

Claims are the moment of truth. That's why we're passionate about making every claim more empathetic, more efficient, and more human. ClaimSorted is an AI-native Third Party Administrator that ...

MLabs

Head of Claims

Manhattan, NY · On-site

$150 - $200/hr

  • Medical

  • Retirement

  • PTO

Backed by some of the world's most prestigious investment funds--including Y Combinator, Atomico, and Eurazeo--our client manages claims operations across the US, UK, and Europe for leading MGAs ...

Amwins

Self-Funded Director, Claims

Tampa, FL

The 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 ...

Amwins

Self-Funded Director, Claims

Tampa, FL · On-site

  • PTO

The 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 ...

Amwins

Self-Funded Director, Claims

Phoenix, AZ · On-site

The 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 ...

Amwins

Self-Funded Director, Claims

Scottsdale, AZ · On-site

  • PTO

The 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 ...

Amalgamated Life

Director, Claims

White Plains, NY · Hybrid

  • Medical

  • Dental

  • Vision

  • PTO

Direct and oversee the activities, tasks, and processes of all claims handling including payments, denials, or pending of all disability, Paid Family Leave, Critical Illness/Accident, medical, vision ...

Amalgamated Life

Director, Claims

White Plains, NY · Hybrid

  • Medical

  • Dental

  • Vision

  • PTO

Direct and oversee the activities, tasks, and processes of all claims handling including payments, denials, or pending of all disability, Paid Family Leave, Critical Illness/Accident, medical, vision ...

ChristianaCare

Director Claims Management

Wilmington, DE · On-site

$121K - $193K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

As Director of Claims Management , you'll play a critical leadership role in protecting one of the nation's leading health systems by directing complex professional and general liability claims ...

Amalgamated Life

Director, Claims

White Plains, NY · On-site

  • Medical

  • Dental

  • Vision

  • PTO

Direct and oversee the activities, tasks, and processes of all claims handling including payments, denials, or pending of all disability, Paid Family Leave, Critical Illness/Accident, medical, vision ...

Chubb Insurance Hong Kong

Claims Director

Simsbury, CT · On-site

$130 - $170/hr

Working out of our Simsbury, CT and soon to be Windsor, CT office The Claim Director, under minimal direction from the manager, investigates and settles litigated claims promptly, equitably and ...

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Director Of Claims information

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$83.5K

$126.9K

$178K

How much do director of claims jobs pay per year?

As of Aug 17, 2026, the average yearly pay for director of claims in the United States is $126,879.00, according to ZipRecruiter salary data. Most workers in this role earn between $105,500.00 and $141,000.00 per year, depending on experience, location, and employer.

What does a director of claims do?

A Director of Claims oversees an organization's claims department, managing the process of evaluating, investigating, and resolving insurance claims. They develop and implement policies to ensure fair and efficient handling of claims, supervise claims managers and adjusters, and ensure compliance with regulatory standards. Additionally, they analyze claims trends, manage budgets, and work to minimize fraud and losses for the company. Their leadership helps maintain customer satisfaction and the financial health of the organization.

How does a director of claims typically collaborate with other departments to improve claims processing efficiency?

A Director of Claims often works closely with departments such as underwriting, legal, customer service, and IT to streamline claims processes and resolve complex cases efficiently. They may participate in cross-functional meetings to identify bottlenecks, implement new technologies, and ensure compliance with regulations. This collaborative approach helps align organizational goals, improve communication, and ultimately enhance the overall customer experience while reducing operational costs.

What are the key skills and qualifications needed to thrive as a director of claims, and why are they important?

To thrive as a Director of Claims, you need extensive knowledge of insurance claims processes, strong analytical abilities, and typically a bachelor's degree in business, finance, or a related field. Familiarity with claims management software, regulatory compliance systems, and industry certifications like AIC (Associate in Claims) is highly valued. Leadership, strategic decision-making, and excellent communication skills are crucial for managing teams and collaborating with stakeholders. These competencies ensure efficient claims operations, regulatory compliance, and positive outcomes for both clients and the organization.

What is the difference between Director Of Claims vs Claims Manager?

AspectDirector Of ClaimsClaims Manager
ResponsibilitiesOversees entire claims department, develops strategies, manages senior staffManages daily claims operations, supervises claims adjusters, ensures claims processing efficiency
Required CredentialsBachelor's degree, industry certifications (e.g., CPCU, ARM), extensive claims experienceBachelor's degree, claims experience, relevant certifications often preferred
Work EnvironmentExecutive leadership setting, strategic planning, cross-department collaborationOperational setting, direct supervision of claims staff, customer interaction

The main difference between a Director Of Claims and a Claims Manager lies in scope and level of responsibility. The Director focuses on strategic oversight and department leadership, while the Claims Manager handles daily operations and team management. Both roles require relevant industry experience and certifications, but the Director's role is more strategic and senior.

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Director Of Claims jobs near you
Infographic showing various Director Of Claims job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 12% Part Time, 1% Temporary, and 1% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $126,879 per year, or $61 per hour.

Director of Claims & Stop-Loss Transformation - REMOTE

S&S Healthcare

Cincinnati, OH • On-site

$120K - $160K/yr

Other

Posted 25 days ago

Job description

Reflect Health is the evolution of S&S Health, a trusted independent third-party administrator founded in 1994 to meet the growing need for access, simplified connectivity, and benefits administration. Headquartered in Mason, OH, we have built a reputation based on innovation, service excellence, and a deep understanding of how to drive better outcomes at lower cost. Over the years, we grew into a national presence serving employers, TPAs, health systems, and benefit consultants across all 50 states. We developed proprietary claims technology, expanded our offerings to include level-funded and fully funded programs, and delivered tangible savings and enhanced experiences for millions of members.

We are seeking a Director of Claims & Stop-Loss Transformation to lead strategic modernization initiatives that advance the future capabilities of our claims and stop-loss platforms. Reporting to the Chief of Staff, Transformation Office, this role serves as a transformation leader responsible for assessing current-state capabilities, identifying operational gaps, designing future-state operating models, and leading complex initiatives that improve scalability, efficiency, quality, and organizational performance. This role will partner closely with Executive Leadership, Claims Operations, Stop-Loss, Technology, Finance, Compliance, Client Success, and operational teams to evaluate current performance, redesign workflows, establish accountability structures, and execute transformation initiatives that enable operational excellence. The ideal candidate is an experienced healthcare transformation with expertise in self-funded health plan administration, claims operations, stop-loss administration, business process redesign, technology enablement, operational analytics, and organizational change management. This individual must be comfortable operating as both a strategic transformation leader and a hands-on operator capable of driving measurable improvements across core TPA functions.

Responsibilities

Transformation Strategy & Future-State Design

Evaluate current-state claims and stop-loss capabilities, including processes, technology platforms, organizational structures, workflows, controls, compliance posture, and performance trends.
Conduct structured assessments to identify operational gaps, root causes, scalability challenges, and improvement opportunities.
Develop future-state operating models, transformation strategies, and implementation roadmaps aligned with Reflect Health’s long-term growth objectives.
Establish transformation priorities, milestones, implementation plans, and success measures.
Provide executive leadership with strategic recommendations, business cases, and investment priorities for transformation initiatives.
Establish baseline KPIs, operating cadences, and accountability structures to measure transformation progress.

Business Process Transformation

  • Lead enterprise process redesign initiatives focused on simplifying workflows, reducing administrative complexity, improving operational scalability, and enhancing service performance.
  • Conduct process assessments, workflow analysis, process mapping, and root-cause evaluations to identify improvement opportunities. Establish transformation priorities, milestones, and implementation plans.
  • Redesign workflows and operating models to improve efficiency, quality, and consistency, as well as the development of standardized procedures, governance models, and operational accountability structures.
  • Facilitate cross-functional design sessions to develop sustainable future-state processes.

Claims & Stop-Loss Modernization

  • Lead modernization efforts across claims and stop-loss administration, including specific and aggregate claim processes, reporting workflows, filing timelines, and recovery processes
  • Evaluate end-to-end claims workflows, including intake, adjudication, payment, quality processes, and exception management, to identify opportunities for improvement.
  • Identify opportunities to reduce claims errors, rework, pend volume, manual intervention, and service-level misses.
  • Support initiatives that improve claims effectiveness, operational consistency, automation, and organizational readiness.
  • Partner with Operations leaders to improve claims quality frameworks, root-cause feedback loops, and continuous improvement practices.
  • Assess opportunities to improve plan configuration discipline, auto-adjudication rates, eligibility administration, and EDI processes.
  • Support automation opportunities for high-dollar claim identification, filing triggers, and exception management.

Technology Enablement & Automation

  • Partner with Technology teams to translate business opportunities into system enhancements, automation opportunities, platform improvements, and data-driven solutions.
  • Support evaluation of technology capabilities and recommend enhancements that enable future-state operations.
  • Identify opportunities for workflow automation, TPA platform optimization, EDI improvements, and operational enablement solutions.
  • Drive alignment between business strategy, operational needs, and technology investments.
  • Support development of operational dashboards and reporting capabilities that improve leadership visibility into performance trends, risks, and opportunities.

Transformation Governance & Measurement

  • Establish transformation governance frameworks, initiative tracking, executive reporting, and benefit realization processes.
  • Define transformation success measures related to claims performance, operational efficiency, stop-loss effectiveness, automation adoption, and service improvements.
  • Develop executive-level dashboards and communications related to transformation initiatives.
  • Provide leadership visibility into progress, risks, dependencies, and outcomes.

Change Management & Stakeholder Alignment

  • Lead organizational change efforts required to successfully implement new processes, technologies, and operating models.
  • Build alignment among teams, and facilitate communication, adoption planning, and organizational readiness activities.
  • Partner with operational leaders to ensure redesigned processes are successfully implemented and sustained.

Qualifications

Industry Experience

  • Significant leadership experience within a third-party administrator (TPA), self-funded health plan, managed care, or health insurance organization.
  • Deep understanding of claims operations, stop-loss administration, employer-sponsored health plans, and healthcare administration workflows.
  • Experience with self-funded plan mechanics, ASO arrangements, stop-loss contract structures, and carrier relationships preferred.
  • Knowledge of employer group, broker, TPA, and stop-loss carrier dynamics.

Transformation Leadership

  • Demonstrated success leading healthcare transformation initiatives, business process redesign, operational modernization, and enterprise change programs.
  • Experience developing future-state operating models, transformation roadmaps, and scalable operating processes.
  • Proven ability to identify operational gaps, define improvement opportunities, and drive implementation across organizational boundaries.
  • Ability to influence executive stakeholders and lead complex initiatives involving multiple business functions.

Process & Technology Expertise

  • Experience partnering with Technology teams to implement workflow automation, platform enhancements, data improvements, and operational enablement solutions.
  • Strong understanding of healthcare administration systems, EDI transactions, claims workflows, and operational processes.
  • Experience leveraging operational data, reporting tools, and analytics to identify root causes and support business decisions.
  • Familiarity with claims technology platforms, workflow tools, automation solutions, and operational reporting capabilities.

Claims & Stop-Loss Expertise

  • Experience improving claims accuracy, workflow efficiency, operational performance, and service-level outcomes.
  • Understanding of stop-loss administration processes, including specific and aggregate claims, filing requirements, recoveries, and carrier coordination.
  • Familiarity with healthcare compliance requirements, including No Surprises Act, ACA reporting, and Continuity of Care requirements preferred.

Leadership & Communication

  • Strong analytical, strategic thinking, and problem-solving capabilities.
  • Excellent communication and stakeholder management skills.
  • Ability to translate complex operational challenges into actionable transformation strategies.
  • Ability to operate effectively in environments requiring cross-functional influence, organizational change, and continuous improvement.

Reflect Health is committed to providing a safe and secure workplace for all employees. All final candidates will be subject to background checks and drug screening as part of the hiring process.