Sample Job Description for Claims Service and Operations Director
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Claims Service and Operations Director Job Overview
Claims Service and Operations Director Job Description Sample
Directs and oversees the operations of an insurance claims department to meet operational, financial, and service requirements.
JOB LEVEL
M04
EDUCATION/DEGREE
Bachelor's Degree
REPORTS TO
Top Management
Salary Range
BASE 50%
$200,800
TOTAL 50%
$240,100
Job Responsibilities for Claims Service and Operations Director
Establishes policies and procedures for the administration of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Responsible for the strategic processing and payment of claims. Maintains up-to-date- knowledge of legislation, regulations, and industry events which pertain to insurance claims. Provides expert guidance and consultation to staff on the most complex claims.
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View Job Description Templates of Similar Jobs
| Job Title | Job Description | |
|---|---|---|
| 1 | Vice President of Claims | The Vice President of Claims is responsible for managing and implementing claims programs for all lines of insurance. Plans and directs all aspects of an organization's insurance claims function. Being a Vice President of Claims develops procedures and policies to enhance and improve the processing, investigation, and settlement of claims. Directs the review and settlement of complex or high dollar claims. In addition, Vice President of Claims ensures legal examinations are made when appropriate. Requires a bachelor's degree. Typically reports to top management. The Vice President of Claims manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. Comprehensive knowledge of the overall departmental function. Working as a Vice President of Claims typically requires 8+ years of managerial experience. |
| 2 | Claims Examinations/Adjustments Manager | The Claims Examinations/Adjustments Manager oversees the investigation, evaluation, negotiation, and settlement of claims to meet operational, financial, and service requirements. Manages the operations of an insurance claims department to ensure timely, accurate, and compliant claims handling. Being a Claims Examinations/Adjustments Manager reviews complex or high-exposure claims and provides technical guidance and settlement authority to staff. Develops and enforces procedures, quality controls, and performance metrics to maintain consistency and compliance. In addition, Claims Examinations/Adjustments Manager monitors caseloads, productivity, and reserve accuracy to meet departmental goals. Ensures compliance with applicable regulations, company policies, and customer service expectations. Requires a bachelor's degree. Typically reports to a director. The Claims Examinations/Adjustments Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Working as a Claims Examinations/Adjustments Manager typically requires 5 years experience in the related area as an individual contributor. 1-3 years supervisory experience may be required. Extensive knowledge of the function and department processes. |
| 3 | Claims Payment Clerk I | The Claims Payment Clerk I inputs claim information into system for processing. Reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Being a Claims Payment Clerk I calculates settlement amounts according to guidelines. Verifies coverage eligibility. In addition, Claims Payment Clerk I processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. Being a Claims Payment Clerk I works under the close direction of senior personnel in the functional area. Possesses a moderate understanding of general aspects of the job. May require 0-1 year of general work experience. |
| 4 | Strategic Sales Director | The Strategic Sales Director sets short- and long-term sales strategies and evaluates effectiveness of current sales programs. Directs and oversees an organization's sales policies, objectives, and initiatives. Being a Strategic Sales Director requires a bachelor's degree. Recommends product or service enhancements to improve customer satisfaction and sales potential. In addition, Strategic Sales Director typically reports to an executive. The Strategic Sales Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. Working as a Strategic Sales Director typically requires 5+ years of managerial experience. |
| 5 | Claims Payment Clerk II | The Claims Payment Clerk II inputs claim information into system for processing. Reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Being a Claims Payment Clerk II calculates settlement amounts according to guidelines. Verifies coverage eligibility. In addition, Claims Payment Clerk II processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. Being a Claims Payment Clerk II works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. Working as a Claims Payment Clerk II typically requires 1-3 years of related experience, or may need 0 years of experience with additional specialized training and/or certification. |
Claims Service and Operations Director Skills & Proficiency Level
| Skills | Proficiency Level |
|---|---|
| Business Process Improvement | Level 4 |
| Standard Operating Procedures (SOP) | Level 4 |
| Budgeting | Level 3 |
