Claims Governance Leader, Employee Benefits (HYBRID or REMOTE)

About the Role

At Equitable, we help clients secure their financial well-being so they can pursue long and fulfilling lives—a mission we’ve honed since 1859. The Claims Governance role will own and lead critical aspects of our Employee Benefits Claims organization, including Quality Assurance, Vendor/TPA Engagements, Inventory Management, Capacity Models, Controls, Training, and Policies and Procedures. Reporting directly to the Head of Claims, this role is pivotal in ensuring efficient and effective processing of claims, compliance with regulatory standards, and meeting the diverse needs of our clients. This individual must translate Employee Benefits’ “Powerfully Simple” vision into actionable, quantitative, and innovative plans, including leading the design, ideation, and build of a Claims Governance framework for Employee Benefit Claims.

This position offers a flexible work schedule: it may be fully remote or hybrid. If you are located near one of our offices (e.g., Charlotte, NC; New York, NY; Syracuse, NY), a hybrid schedule with 2–3 days on-site per week is expected to foster collaboration and connection.

Responsibilities

• Creates and executes on Employee Benefit’s Claims Excellence and Governance strategy, including ownership for Quality, Training, Vendor/TPA Engagements, and Policies & Procedures.
• Ensures the timely deployment of talent and processes in support of both the initial build/implementation of the EB Claims Governance organization and ongoing execution of the strategy.
• Responsible for creating a strategic approach to setting, monitoring, and executing key performance indicators to drive a positive customer experience.
• Responsible for overseeing the quality assurance of claims processing, ensuring accuracy, timeliness, and compliance with policies and regulations.
• Responsible for oversight of new and existing TPA and vendor engagements/relationships, ensuring they meet contractual obligations and service level agreements (SLAs).
• Oversees the design, development, and execution of an EB Claims training program, encompassing both new hire training and ongoing learning and development needs.
• Leads a robust policies and procedures framework to ensure processes and expectations are clearly defined, well-documented, and accessible to all applicable parties.
• Leads and manages a robust organization, including attracting and retaining top industry talent and fostering a culture of collaboration, innovation, and continuous improvement.
• Collaborates with internal departments, external partners, and other key stakeholders to execute a market-leading strategy.
• Performs other duties as assigned.

Requirements

• 10+ years of experience in Employee Benefits or Group Insurance Claims
• 5+ years of people leadership experience with excellent team management abilities
• Professional work experience with one or more of the following Claims functions: Quality Assurance, Training, Vendor/TPA Engagements, Inventory Management, Compliance, and Policies/Procedures

Preferred Qualifications

• Strong analytical, strategic thinking, and problem-solving skills
• Strong understanding of technology and industry trends
• Proven track record of innovative problem solving
• Strong verbal, written communication, and presentation skills
• Comfortable dealing with complexity and ambiguity and able to explore multiple solutions
• Strategic visionary who develops, communicates, and executes a compelling vision

Skills

• Claims Excellence: Knowledge of building and deploying a total quality framework, with the ability to implement strategies and techniques used to ensure that claims processing meets the highest standards of accuracy and compliance.
• Effective Communications: Understanding of effective communication concepts, tools, and techniques; ability to effectively transmit, receive, and accurately interpret ideas, information, and needs through the application of appropriate communication behaviors.
• Leadership: Knowledge of leadership practices and processes; ability to use strategies and skills to enlist others in setting, embracing, and achieving objectives while having a long-term perspective of the future state and how to get there.
• Planning: Tactical, Strategic: Knowledge of effective planning techniques and ability to contribute to operational (short term), tactical (1-2 years), and strategic (3-5 years) planning in support of the overall business plan.
• Product and Vendor Evaluation: Knowledge of product and vendor evaluation; ability to implement processes for the evaluation and selection of products, tools, services, and infrastructure components ensuring they are in line with an organization's business needs and architectural principles.
• Project Management: Knowledge of effective project management strategies and tactics; ability to plan, organize, monitor, and control projects, ensuring efficient utilization of technical and administrative resources to achieve project objectives.
• Data Analysis and Interpretation: Proficiency in data analysis techniques and tools; ability to interpret complex data sets to make informed decisions and drive continuous improvement initiatives. This includes the ability to use statistical methods and software to identify trends, root causes, and opportunities for quality enhancement.

Pay

The base salary range for this position is $145,000 - $170,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.

Benefits

For eligible employees, Equitable provides a full range of benefits, including medical, dental, vision, a 401(k) plan, and paid time off.

About Equitable

At Equitable, we’re a team committed to helping our clients secure their financial well-being so they can pursue long and fulfilling lives. We turn challenges into opportunities by thinking, working, and leading differently—where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities. We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork.