Director, Claims Solutions

The Claims Solution Leader is a senior-level role responsible for the strategy, performance, and growth of CBCS's ancillary claim solutions portfolio. This leader oversees vendor partnerships, solution design, financial performance, and go‑to‑market execution. The role ensures that CBCS delivers high‑value, best‑in‑class solutions that improve claim outcomes and support organizational growth.

This position partners closely with claims operations, sales, marketing, finance, and executive leadership to embed solutions into workflows, strengthen client value, and drive adoption across the organization.

Key Responsibilities:

Vendor & Solution Management

• Select, negotiate, and manage relationships with solution providers.
• Monitor vendor performance using KPIs and service standards.
• Lead continuous improvement based on data insights and client feedback.
• Maintain strong SLAs and overall service quality.

Strategy & Market Positioning

• Develop go‑to‑market strategies and positioning for claim solutions.
• Identify emerging trends and technologies to enhance offerings.
• Partner with sales and marketing to create value propositions and materials.
• Build integrated, high‑value solution packages for clients.

Financial Leadership

• Oversee profitability and financial performance of all solution lines.
• Develop pricing strategies, ROI analyses, and cost‑benefit models.
• Manage budgets and report results to senior leadership.

Utilization & Adoption

• Drive increased utilization, penetration, and standardization across clients.
• Partner with claims leadership to embed solutions into workflows.
• Identify cross‑sell and up‑sell opportunities.
• Lead change management efforts to support internal adoption.

Training & Collaboration

• Serve as subject matter expert for CBCS claim solutions.
• Deliver training for claims, account management, and client service teams.
• Develop best-practice resources and solution documentation.
• Foster strong cross-functional collaboration.

Qualifications:

Required

• Bachelor's degree in Business, Risk Management, Insurance, Healthcare Administration, or related field.
• 10+ years of progressive experience in Property & Casualty claims.
• Deep knowledge of managed care, litigation support, investigation, and Medicare compliance solutions.
• Proven vendor management and contract negotiation experience.
• Experience driving solution utilization and financial performance.
• Strong financial analysis and P&L experience.

Preferred

• Master's degree or designations (ARM, CPCU, AIC, CCM, etc.).
• Experience in a TPA environment.
• Advanced knowledge of Medicare compliance.
• Background in program implementation or change management.
• Familiarity with claims technology platforms.

Travel:

Travel approximately 25–30% for vendor visits, conferences, client engagements, and internal training.