Sr. Manager, Claims Operations

About the role

Responsibilities

Claims Operating Model & Process Excellence

• 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.

Carrier Partner Reporting & Claims Bordereaux (BDX)

• 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.

Loss Fund Operations & Claims Payments Enablement

• 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.

Technology Enablement & Data Quality

• 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.

Controls, Compliance, and Audit Readiness

• 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.

Team Leadership: Managing Claims Operations Associates

• 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.

Cross-Functional & External Partnerships

• 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.

Skills and Qualifications

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

Leadership attributes

• 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.

Compensation

Our compensation reflects the cost of labor across several US geographic markets. The US base salary for this position ranges from $126,000/year in our lowest geographic market up to $190,000/year in our highest geographic market. Consistent with applicable laws, an employee's pay within this range is based on a number of factors, which include but are not limited to relevant education, skills, job-related knowledge, qualifications, work experience, credentials, and/or geographic location. Your recruiter can share more on target salary for your location during the interview process. Coalition, Inc. reserves the right to modify this range as needed.

Perks

• 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