Claims Program Director

Provides centralized program management and oversight across the Claims organization, coordinating modernization, optimization, operational initiatives, technology and system enhancements, reporting, and other claims-related projects to ensure priorities, dependencies, risks, and outcomes are effectively managed. Serves as a key liaison between Claims operations, technology, data/reporting teams, and other cross-functional stakeholders to translate business needs into executable solutions and successful implementations on time and on budget.

Core Scope
• Claims modernization initiatives
• Strategic and operational Claims initiatives
• Claims optimization initiatives
• Claims technology and system enhancement coordination
• Business requirements development, documentation, and validation
• User acceptance testing (UAT), defect tracking, implementation readiness, and post-production validation
• Small Block TPA enhancements
• Cross-functional Claims projects
• Service desk and project ticket coordination
• Claims reporting and oversight
• Program governance, milestones, risks, dependencies, and executive-level status reporting

Technical Experience & Competencies
• Demonstrated experience managing technology-enabled operational projects, preferably within insurance, claims, long-term care, or TPA environments.
• Experience translating business and operational needs into business requirements, functional requirements, process flows, user stories, and acceptance criteria.
• Working knowledge of system development and enhancement lifecycles, including requirements gathering, design, testing/UAT, defect resolution, implementation, and post-production validation.
• Experience coordinating service desk tickets, system defects, enhancement requests, and project work across business and technology teams.
• Strong understanding of data, reporting, and operational metrics, with experience using reporting and analytical tools such as Power BI and Excel.
• Ability to assess the downstream operational, reporting, workflow, and control impacts of technology changes.
• Experience coordinating testing efforts, including development of test scenarios, documentation of results, defect prioritization, and validation of corrective actions.
• Ability to communicate technical concepts in clear business terms and serve as an effective bridge between Claims operations, IT, product owners, developers, analysts, and business stakeholders.
• Familiarity with workflow automation, digital claims capabilities, AI-enabled solutions, and process optimization is preferred.