Director, Claims Solutions

Key Responsibilities

Vendor & Solution Management

• Select, negotiate, and manage relationships with solution providers.
• Monitor vendor performance using KPIs and service standards.
• Lead continuous improvement based on data insights and client feedback.
• Maintain strong SLAs and overall service quality.

Strategy & Market Positioning

• Develop go‑to‑market strategies and positioning for claim solutions.
• Identify emerging trends and technologies to enhance offerings.
• Partner with sales and marketing to create value propositions and materials.
• Build integrated, high‑value solution packages for clients.

Financial Leadership

• Oversee profitability and financial performance of all solution lines.
• Develop pricing strategies, ROI analyses, and cost‑benefit models.
• Manage budgets and report results to senior leadership.

Utilization & Adoption

• Drive increased utilization, penetration, and standardization across clients.
• Partner with claims leadership to embed solutions into workflows.
• Identify cross‑sell and up‑sell opportunities.
• Lead change management efforts to support internal adoption.

Training & Collaboration

• Serve as subject matter expert for CBCS claim solutions.
• Deliver training for claims, account management, and client service teams.
• Develop best-practice resources and solution documentation.
• Foster strong cross-functional collaboration.

Qualifications

Required

• Bachelor’s degree in Business, Risk Management, Insurance, Healthcare Administration, or related field.
• 10+ years of progressive experience in Property & Casualty claims.
• Deep knowledge of managed care, litigation support, investigation, and Medicare compliance solutions.
• Proven vendor management and contract negotiation experience.
• Experience driving solution utilization and financial performance.
• Strong financial analysis and P&L experience.

Preferred

• Master’s degree or designations (ARM, CPCU, AIC, CCM, etc.).
• Experience in a TPA environment.
• Advanced knowledge of Medicare compliance.
• Background in program implementation or change management.
• Familiarity with claims technology platforms.

Travel

Travel approximately 25–30% for vendor visits, conferences, client engagements, and internal training.