CLAIMS OPERATIONS MANAGER JOB DESCRIPTION

P&C carriers processing thousands of First Notice of Loss calls annually depend on accurate reserving and adjuster licensing compliance in every jurisdiction where they write business. Four metrics tell the story before a single file closes: reserve adequacy, cycle time, litigation rate, and customer service scores. When those numbers drift, the failure traces back to a gap in claims leadership. The Claims Operations Manager owns that accountability - overseeing file handling standards, staffing models, and continuous improvement efforts that keep operations running within regulatory and corporate guidelines.

You will own the end-to-end operational performance of a P&C claims unit, serving as the Claims Operations Manager who sets service levels, directs workflow design, and holds the team accountable to adjuster licensing requirements and loss-outcome targets. A team of claims handlers and specialists reports through this seat, with scope spanning FNOL intake through complex file resolution and periodic presentation to Claims Governance leadership.

Career Impact: Hands-on authority over reserving decisions, litigation management, and multi-state adjuster licensing positions you for advancement into regional or enterprise claims leadership in the P&C market.

Business Impact: The workflows and service levels this role establishes directly shape how policyholders experience the claim process at its most stressful point, influencing renewal decisions and loss ratios across the book.

Growth Opportunity: Exposure to underwriter and actuary interfaces, combined with ownership of a departmental budget, builds the financial and cross-functional fluency that P&C director-level roles require.

• Lead daily claims operations for a team of handlers, setting file authority levels and workload priorities to maintain service standards.
• Direct the design and ongoing maintenance of FNOL workflows and claim handling procedures to maximize efficiency and customer experience.
• Monitor file progression on high-severity and litigation-tracked losses, participating in review sessions to determine case direction.
• Establish service-level targets for the claims unit and adjust staffing models and resource allocation when volume or performance deviates.
• Review quality audit results and enforce corrective action plans to address identified deficiencies in documentation or settlement practices.
• Oversee adjuster licensing compliance, ensuring team members obtain and maintain required P&C licenses and continuing education credits across all applicable jurisdictions.
• Collaborate with underwriters and actuaries on claims trends, coverage developments, and reinsurance reporting to inform business planning.
• Develop and present periodic operational reports to senior claims leadership, including semi-annual governance meetings.

• Bachelor's degree in business administration, insurance, or a related field, or equivalent work experience.
• 5 or more years of P&C claims leadership experience, with demonstrated responsibility for team performance and file outcomes.
• Working knowledge of insurance coverage principles, liability analysis, and reserving practices in property and casualty lines.
• Valid P&C adjuster license in applicable jurisdictions, or demonstrated ability to obtain required licenses within the first 90 days of employment.
• Proven experience managing staffing models, departmental budgets, and workload distribution in a claims environment.
• Strong written and verbal communication skills, including the ability to present performance data and claims trends to senior leadership.
• Demonstrated ability to conduct or oversee quality audits and implement continuous improvement processes.
• Experience coordinating with legal counsel on litigation management and complex claim resolution strategies.

• CPCU or AIC designation, or active pursuit of either, indicating advanced P&C technical grounding.
• Familiarity with FNOL operations, including blended inbound and outbound call center environments within a claims context.
• Experience interfacing with actuarial or underwriting functions on loss trend analysis and coverage changes.
• Prior exposure to reinsurance reporting requirements or surplus lines compliance obligations.

• Reserve adequacy rate, measuring how closely initial reserves reflect final settlement values across the managed book.
• Average claim cycle time in days, tracking how efficiently files progress from FNOL through closure.
• Adjuster licensing compliance rate, reflecting whether all required state licenses and CE credits are current across the team.
• Quality audit pass rate per review period, indicating whether file documentation and settlement practices meet established standards.
• Litigation rate as a percentage of open files, measuring how effectively early intervention reduces escalation to legal proceedings.
• Typical tools: Claims management systems (commonly Guidewire or Duck Creek); document and reporting platforms (commonly Salesforce or internal portal).

• Base Salary Range: $95,000 to $135,000 annually, depending on experience and market
• Bonus: Annual performance bonus, typically 10% to 15% of base salary
• Equity: Not typical; occasional long-term incentive plans at senior tier
• Health Benefits: Medical, dental, and vision coverage; employer-subsidized premiums standard
• PTO: 15 to 20 days annually plus standard federal holidays
• Common Perks: Adjuster licensing reimbursement, continuing education support, remote or hybrid schedule options

Figures are estimates based on general US market benchmarks and may be outdated. Adjust based on location, company size, and seniority level.

Successful completion of a background check and, where applicable, a motor vehicle record review is a condition of employment. All qualified applicants will be considered without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other characteristic protected under applicable federal, state, or local law. Reasonable accommodations are available to individuals with disabilities throughout the application and employment process upon request. Candidates must be authorized to work in the United States.

The Claims Operations Manager oversees commercial trucking liability claims spanning coverage analysis, reserving, litigation management, and settlement, while also delivering training and mentoring throughout the claim process. Reporting to senior leadership and interfacing with underwriters and actuaries, the role shapes departmental standards and drives adherence to corporate and regulatory requirements across the claims unit.

Key Responsibilities

• Oversee the handling of all aspects of claims, including training on reserving, communication, documentation, litigation management, evaluation, negotiation and settlement.
• Ensure complete and sound claim settlements, legal reviews and investigations.
• Monitor file progression including trial activity on files with significant loss impact and participate in file review sessions to determine direction.
• Plan, prioritize and assign workload to ensure prompt file handling and maintain work production.
• Direct the implementation and ongoing maintenance of claims handling systems, policies and procedures.
• Provide file authority as appropriate to staff.
• Review quality audit results to ensure deficiencies are addressed.
• Prepare regular periodic reports and monitor system reports to ensure adherence to corporate and regulatory standards.
• Establish and execute controls to ensure that the quality of the work meets or exceeds standards.
• Review and analyze processes, procedures, and workflows to identify opportunities for process improvement and efficiency.
• Participate in the specialized handling of complex claim matters and projects requiring advanced claim knowledge and experience.
• Provide personnel administration including selection, training, performance appraisals, salary administration, employee development, and affirmative action.
• Communicate with upper-level management regarding training techniques, complaints, new coverages or laws, and reinsurance reporting.
• Assist in the preparation and management of the departmental budget and manage expenses.
• Interface with relevant underwriters and actuaries on claims trends and underwriting business plans.

Education & Experience

• Bachelor's degree in insurance, management, or business administration preferred, or equivalent knowledge and skills.
• 10 or more years of claim handling experience in commercial trucking insurance lines of business.
• Thorough understanding of laws, principles of coverage, liability, and the insurance industry.
• Technical knowledge of insurance policies and coverages, with analytical ability to make essential decisions when necessary.
• Proficient in operating business technology relevant to claims management functions.
• Strong leadership skills with the ability to plan, organize, delegate, and develop staff.
• Effective written and verbal communication skills, with the ability to obtain and deliver information at all levels.
• Capable of carrying out detailed written and verbal instructions with little supervision.
• Valid adjuster's license in applicable jurisdictions, or demonstrated ability to obtain such.

Embedded within an insurance or claims department, the Claims Operations Manager leads a team of claims handlers to achieve agreed service and performance objectives while fostering a continuous learning environment. Working closely with team members through regular one-on-one meetings and quality checks, the role advances operational efficiency and customer experience through targeted process improvements and complaint management.

Core Functions

• Lead a team of claims handlers to achieve agreed objectives.
• Conduct regular one-on-one meetings and check-ins with team members.
• Proactively identify and address team training needs, encouraging an environment of continuous learning.
• Carry out quality checks and provide positive and constructive feedback.
• Authorize payments within agreed threshold limits.
• Identify process and product improvement opportunities and actively drive changes to improve efficiency or customer experience.
• Manage first-line complaints in line with agreed protocols.
• Communicate process changes clearly and effectively to the team.

Required Qualifications

• 3 or more years of experience working in an insurance or claims department, preferably with people management responsibility.
• Effective at coaching and developing others and actively sharing knowledge and experience.
• Skilled in data-driven decision-making, using insight and information to reach sound outcomes.
• Proficient in time management and multitasking to manage concurrent responsibilities effectively.
• Self-motivated with the ability to motivate others and work effectively under pressure.
• Comfortable with leadership responsibility while functioning as part of a wider management team.
• Positive, approachable, and resilient, with strong interpersonal skills at all levels.

Reporting to financial crimes management, the Claims Operations Manager leads a blended team of analysts and specialists responsible for inbound and outbound fraud prevention, covering proactive identification, detection and recovery across multiple systems. Partnering with Learning and Development and cross-functional departments, the role delivers compliance with Bank Secrecy Act, USA PATRIOT Act and FACTA requirements while building staff capability through structured coaching and training programs.

Primary Duties

• Supervise a team of specialists responsible for a financial crimes program covering proactive identification, prevention, detection and recovery.
• Manage a complex blended function, including performance coaching to call center production metrics.
• Resolve escalated issues and communicate with customers, vendors and other departments.
• Manage queue distribution, ongoing production and workflow improvement efforts.
• Implement department policies and procedures to maximize efficiency, customer service and compliance with government regulations.
• Ensure compliance with regulatory requirements such as the Bank Secrecy Act, USA PATRIOT Act, and FACTA.
• Participate in audit and exam preparations and manage business safety through day-to-day risk management.
• Assist in establishing performance standards, evaluating performance, and training and coaching staff.
• Develop training materials and facilitate classroom and one-on-one training in partnership with Learning and Development.

Qualifications & Experience

• 1 or more years of fraud prevention or claims experience.
• Leadership experience, including coaching, training and mentoring.
• Knowledge of ATM, ACH, check fraud and debit card claim processing.
• Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint.
• Ability to prioritize work, meet deadlines and perform under pressure in a complex environment.
• Motivated self-starter with the ability to provide performance feedback and motivate staff.
• Strong analytical skills with close attention to detail and accuracy.
• Solid conflict management and decision-making skills.
• Excellent verbal, written, and interpersonal communication skills.
• Bilingual proficiency in Spanish and English, including speaking, reading, and writing.

The Claims Operations Manager leads the development and implementation of a team-based approach to First Notice of Loss calls and low-severity claims, designing workflows and overseeing operations to deliver timely handling and exceptional service from initial contact. Operating across claims leadership, business partners, and the claim supervisor team, the role builds staffing models, governs adjuster licensing compliance, and applies continuous improvement methods to maximize efficiency and customer outcomes.

Duties

• Develop and build an effective team to achieve high levels of customer service.
• Design and implement workflows to ensure tasks are prioritized to maximize service and efficiency.
• Establish service levels for the team and monitor to ensure they are met, making adjustments as needed.
• Manage resources and ensure the team is properly staffed to handle work volume, using a staffing model and establishing an annual budget.
• Build a robust onboarding plan for new and transferred employees.
• Report regularly on team productivity and status, and present at claims governance meetings as needed.
• Apply continuous improvement methods to streamline, standardize, and operationalize workflows with the customer at the forefront.
• Determine appropriate metrics for measuring handler performance and hold the team accountable for results.
• Ensure adjuster licensing and continuing education credits are obtained and maintained.
• Collaborate with claims leadership, key stakeholders, and business partners to accomplish corporate objectives.

Education & Experience

• Bachelor's degree or equivalent professional experience.
• CPCU and/or AIC designation preferred.
• Property/Casualty adjuster license required in all applicable states, to be obtained within three months of employment.
• 5 or more years of P&C claims leadership experience.
• Demonstrated staff management experience, including attracting talent, managing performance and developing capabilities.
• Advanced knowledge of insurance and claims handling principles, practices and procedures, including investigations and resolution.
• Strong analytical and problem-solving skills, with the ability to manage multiple projects and teams simultaneously.
• Proven ability to lead continuous improvement efforts with a broad understanding of operations.
• Strong oral, written, and presentation communication skills, with the ability to communicate effectively with internal and external stakeholders.
• Effective leadership skills, including conflict resolution, goal achievement, and the ability to lead others.

A key member of the regional claims leadership structure, the Claims Operations Manager coordinates change programs, continuous improvement initiatives, and work transfer plans across shared services governance groups and companywide committees. Collaborating across claims managers, regional leaders and shared services partners, the role refines cost-effective claims processes and maintains high-quality reporting aligned with London Market operational strategies.

Functions

• Plan and coordinate regional change programs and continuous improvement initiatives, leading individual workstreams and managing projects.
• Participate as regional transition lead on shared services governance groups.
• Create work transfer plans in partnership with shared services and claims managers to move work to appropriate sites.
• Manage the effectiveness of transitions and the continued performance of transferred services.
• Identify and manage region-specific legal, regulatory, data protection and risk issues.
• Manage the catalogue of existing services and emerging operational opportunities.
• Develop and oversee efficient and cost-effective claims processes, including identification, evaluation and implementation of operational improvements.
• Collaborate with key regional leaders to develop and maintain high-quality reporting and data that supports broader business goals.
• Support the development and execution of the annual planning process for the region.
• Maintain awareness of London Market system and operational strategies and participate to ensure the organization is well positioned for forthcoming changes.
• Champion the priorities of the claims team as a representative on companywide groups and committees relating to processes, systems and budgetary considerations.

Skills & Qualifications

• Claims experience within the London Market.
• Demonstrated resource and project management capabilities.
• Exceptional quantitative and qualitative analysis skills, including trend assessment and data-driven decision support.
• Sound working knowledge of financial and risk analysis.
• Strategic and collaborative thinker with the ability to identify gaps and deliver results through cross-functional collaboration.
• Proficient in developing unstructured data analysis and predictive models with interpretive actions.
• Excellent attention to detail with a meticulous approach to identifying inconsistencies or inaccuracies in data.
• Superior verbal and written communication skills, with the ability to positively engage key stakeholders.
• Proven ability to display initiative and develop disciplined solutions to problems.
• Resilient and adaptable, comfortable managing numerous concurrent responsibilities in a fast-paced environment.

Sr. Claims Operations Manager oversees an enterprise-wide anti-fraud prevention and detection program, providing strategic direction, internal control enhancement, and regulatory reporting of internal and external fraud from a first-line-of-defense perspective. The work directly supports senior and executive management by delivering recurring project roadmaps, Key Performance Indicator reporting, and risk assessment frameworks that minimize fraud exposure and maintain compliance with financial services regulatory requirements.

Strategic Responsibilities

• Oversee enterprise fraud management functions, including prevention, detection, investigations and regulatory reporting.
• Support a culture of compliance through enhancement of the anti-fraud internal control environment.
• Proactively identify, track and analyze fraud risks across the organization.
• Guide business practices, key decisions, policies, internal controls and standards related to anti-fraud measures.
• Promote fraud awareness across the organization through the establishment of an anti-fraud risk assessment program.
• Establish and oversee the fraud assessment as part of the Risk Control Self-Assessment process.
• Implement and manage fraud prevention and investigation programs focusing on identification and prevention across company functions.
• Lead early warning detection systems and other loss mitigation initiatives.
• Coordinate and revise fraud investigation management processes, policies, and procedures at the program level.
• Research and leverage technology-based tools to implement process improvements to fraud monitoring and detection systems.
• Develop and deliver a strategic project roadmap regularly.
• Manage, develop, and report Key Performance Indicators to senior and executive leadership.
• Ensure customer fair treatment processes are in place and regularly reviewed for consistency and effectiveness.

Experience & Qualifications

• Certified Fraud Examiner (CFE) certification preferred or equivalent.
• 7 or more years of experience in financial fraud prevention and investigations, audit or risk functions within a large commercial or investment bank or regulatory agency.
• 5 or more years of experience in enterprise-wide fraud investigation monitoring and reporting programs.
• 3 to 5 years of management experience.
• Working knowledge of consumer and commercial banking and capital markets products.
• Strong understanding of financial services regulatory requirements and current regulatory developments.
• Proficient in database design and analysis, including reconciling large data sets, trend analysis and creating metrics and dashboards.
• Proficient in Microsoft Office, including Excel, PowerPoint and Word.
• Experienced in systems strategy, UAT design and implementation, data integrity and data security.
• Skilled in risk and trend identification, mitigation techniques and translating fraud metrics into predictive action plans.
• Skilled in creating high-impact presentations for diverse audiences, including senior management and regulators.
• Well-developed analytical and problem-solving skills, with the ability to communicate findings and drive change.
• Experienced in influencing and driving initiatives to completion in a matrix reporting environment.
• Strong leadership skills with the ability to manage, develop and motivate a team.
• Strong written and verbal communication skills with the ability to build collaborative relationships across complex business lines.
• Detail-oriented with strong time management skills and the ability to handle multiple tasks and deadlines simultaneously.