VP, Claims Adjudication

Our partner is seeking a VP, Claims Adjudication based in the United States to shape and scale a high-performing claims adjudication organization within a fast-growing, technology-driven insurance environment. This executive leadership role oversees end-to-end workers' compensation claims operations while driving strategic initiatives that improve claim outcomes, operational excellence, and customer experience.

About the role

You will lead the overall claims adjudication function, working closely with executive leadership and cross-functional teams to influence company-wide decisions related to claims, underwriting, technology, and risk management. This role combines operational leadership, organizational development, and innovation, ideal for a seasoned claims executive who thrives in a collaborative, data-driven, and transformation-focused environment.

Responsibilities

• Lead the overall claims adjudication function across multiple jurisdictions, ensuring efficient, compliant, and customer-focused claims operations.
• Develop and execute claims adjudication strategies aligned with broader business objectives and workers' compensation programs.
• Establish policies, procedures, and best practices that improve claim investigations, evaluations, settlements, and operational consistency.
• Oversee the management of complex, litigated, catastrophic, and high-value claims while ensuring optimal financial and customer outcomes.
• Build, lead, and develop a high-performing organization of Directors, Senior Managers, and claims professionals through coaching, succession planning, and performance management.
• Define organizational structures, KPIs, workforce planning, and operational goals that support long-term business growth.
• Manage departmental budgets, financial planning, operational expenses, and performance metrics to drive profitability and continuous improvement.
• Partner with technology, product, and engineering teams to modernize claims operations through automation, digital transformation, and process innovation.
• Collaborate with underwriting, actuarial, finance, legal, compliance, product, and executive leadership on strategic initiatives and enterprise decision-making.
• Ensure compliance with regulatory requirements, oversee risk management practices, and maintain strong relationships with regulatory agencies and industry partners.
• Represent the organization externally as a senior claims expert at industry events, client engagements, and strategic partnerships.

Requirements

• 15+ years of experience in workers' compensation claims, claims adjudication, and field claims operations.
• 10+ years of progressive leadership experience managing large claims organizations and developing senior leaders.
• Demonstrated success managing second-line leaders, including Directors and Senior Managers.
• Deep expertise in workers' compensation regulations, disputed and litigated claims, and multi-jurisdictional claims management.
• Proven ability to design and execute strategic claims initiatives that improve operational performance, financial outcomes, and customer satisfaction.
• Strong understanding of claims analytics, KPIs, budgeting, forecasting, and performance management.
• Experience leading organizational growth, transformation initiatives, and technology-driven process improvements.
• Exceptional leadership, coaching, and talent development skills with a focus on building inclusive, high-performing teams.
• Strong executive presence with outstanding communication, presentation, negotiation, and stakeholder management abilities.
• Proven ability to collaborate across cross-functional executive teams and influence strategic business decisions.
• Experience representing an organization externally as an industry thought leader is highly desirable.
• Bachelor's degree or equivalent professional experience in insurance, business, or a related field is preferred.

Benefits

• Salary: $200,000-$260,000 USD annually.
• Performance-based discretionary bonus opportunities.
• Comprehensive medical, dental, and vision healthcare coverage.
• 401(k) retirement plan with company matching.
• Generous paid time off.
• Paid parental and caregiver leave.
• Fully remote opportunity within the United States.
• Career growth opportunities within a rapidly scaling organization.
• Collaborative, innovative, and mission-driven work culture.