Leads claims operations for a specialty insurance portfolio, managing a team of Program Management Specialists and relationships with TPAs and MGUs. Day to day involves client audits, risk monitoring, reporting, and legal/regulatory coordination. Requires 6+ years in Special Risk/Travel insurance and strong Microsoft Office skills.
Compensation
$61.6K–$115.7K / yr
Location
US
Work setup
Remote
Seniority
Not specified
Employment
Full time
Experience
6+ years
Category
Project management
Posted
Skills
ai
gdpr
program-management
risk-assessment
statistics
Must have
Bachelor's degree from an accredited university or equivalent professional experience
At least 6 years of relevant experience in Special Risk, Travel, and Travel Medical insurance
Strong proficiency with Microsoft Office applications, including Excel, Word, Outlook, and PowerPoint
Proven ability to build strong working relationships with customers, administrators, and colleagues
Demonstrated commitment to high-quality service delivery, customer satisfaction, and effective issue resolution
Strong analytical and problem-solving skills, with the ability to identify operational trends and implement process improvements
Excellent attention to detail and organizational skills, including the ability to manage multiple tasks in a fast-paced environment
Ability to work independently while contributing effectively to a collaborative team
Strong written and verbal communication skills, including the ability to explain complex information clearly
High level of personal accountability and commitment to continuous improvement
Willingness and ability to travel approximately 20%
Nice to have
Experience with specialty insurance products such as Employer Stop Loss, Travel, Short-Term Medical, Medical Travel, Workers' Compensation, and/or Occupational Accident
Full description
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Claims Program Manager based in the United States.
As a Claims Program Manager, you will oversee claims operations and strengthen relationships with third-party administrators (TPAs), managing general underwriters (MGUs), and other business partners within a specialty insurance environment. You will lead and support a team of Program Management Specialists responsible for managing a diverse portfolio of claims clients. Your role will combine relationship management, operational oversight, risk assessment, and performance analysis to ensure claims are handled efficiently and in accordance with policy terms and regulatory requirements. Working closely with internal teams across Underwriting, Actuarial, Compliance, Legal, and IT, you will identify operational challenges and drive practical improvements. You will also contribute to team development, process documentation, and the delivery of consistent, high-quality service. This is an opportunity to make a meaningful impact on client partnerships and claims performance across a growing specialty insurance portfolio.
Accountabilities
In this role, you will oversee program claims activities, support the development of the Program Management team, and ensure strong operational relationships with administrators and business partners. Your responsibilities will include:
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Relationship Management
- Schedule, coordinate, and monitor annual client audits, acting as the primary audit coordinator.
- Review reports prepared by Program Management team members and provide first-level quality assurance.
- Oversee team members managing a diverse portfolio of products, administrators, and client relationships.
- Support a relationship-based service culture through regular engagement with clients and internal stakeholders.
- Act as a liaison between administrative, operational, and underwriting teams to resolve ongoing issues.
- Address sensitive or challenging customer situations professionally and constructively.
- Participate in team members' client meetings and ensure open issues are addressed at least monthly.
- Coordinate with IT to investigate and resolve technical or system-related issues.
- Assign or support the onboarding of new clients and administrative partners.
- Build long-term customer relationships through responsive and professional service.
Claims Program Manager at Jobgether (Remote) — aijobsearch
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Risk Management
- Support due diligence for prospective program administration partners, including onsite reviews and operational assessments.
- Participate in annual administrator reviews to verify compliance with company requirements and identify process gaps or improvement opportunities.
- Monitor claims activity at least quarterly to identify unusual trends or outliers.
- Identify processing, system, and operational issues affecting client or internal operations.
- Help ensure claims are processed and paid consistently with applicable policy terms.
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Reporting and Trend Analysis
- Prepare monthly reporting packages for senior management, including claims inventory, TPA customer service and turnaround statistics, and referral analysis.
- Analyze claims-related litigation and regulatory inquiries monthly to identify trends and potential exposure.
- Review claims referral logs at least quarterly and provide recommendations for potential adjustments to authority levels.
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Legal and Regulatory Coordination
- Refer small claims litigation matters to the Legal team and provide assistance as needed.
- Review attorney correspondence and coordinate appropriate responses with administrators.
- Support the Compliance team in reviewing claims-related regulatory inquiries.
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Best Practices and Process Documentation
- Draft and maintain internal Claims Best Practices documentation covering company and regulatory standards, procedures, and workflows.
- Review and update documentation at least quarterly.
- Oversee the Program Management team's review of TPA best practices.
- Ensure claims administrators understand and follow applicable state unfair claims settlement practices laws.
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Training and Development
- Continue developing the team's knowledge of relevant insurance products and claims processes.
- Help team members adopt a broader operational perspective beyond traditional claims auditing.
- Use real-world situations, including challenges involving administrators, as opportunities for coaching and professional development.
- Perform other related duties as assigned.
Requirements
The ideal candidate combines specialty insurance claims experience with strong analytical, organizational, and relationship management skills. You should be comfortable managing multiple priorities, resolving complex operational issues, and communicating effectively with clients and internal teams. Required qualifications include:
- Bachelor's degree from an accredited university or equivalent professional experience.
- At least 6 years of relevant experience in Special Risk, Travel, and Travel Medical insurance.
- Strong proficiency with Microsoft Office applications, including Excel, Word, Outlook, and PowerPoint.
- Proven ability to build strong working relationships with customers, administrators, and colleagues.
- Demonstrated commitment to high-quality service delivery, customer satisfaction, and effective issue resolution.
- Strong analytical and problem-solving skills, with the ability to identify operational trends and implement process improvements.
- Excellent attention to detail and organizational skills, including the ability to manage multiple tasks in a fast-paced environment.
- Ability to work independently while contributing effectively to a collaborative team.
- Strong written and verbal communication skills, including the ability to explain complex information clearly.
- High level of personal accountability and commitment to continuous improvement.
- Willingness and ability to travel approximately 20%.
Preferred Experience
- Experience with specialty insurance products such as Employer Stop Loss, Travel, Short-Term Medical, Medical Travel, Workers' Compensation, and/or Occupational Accident.
Benefits
- Annual base salary: $61,600–$115,700, depending on location, experience, skills, responsibilities, and performance.
- 401(k) plan with generous employer matching contributions.
- Employee Stock Purchase Plan with employer matching.
- Generous paid time off.
- Comprehensive benefits covering health, dental, and vision, alongside programs supporting physical, mental, and financial well-being for employees and their families.
- Tuition reimbursement.
- Support for industry-related certifications and professional training.
- Career development opportunities and resources to support long-term professional growth.
- Dynamic, collaborative, and inclusive work environment.
- Remote work opportunity.
How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Why Apply Through Jobgether?
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.