Director, Workers’ Compensation Claims Operations – Operational Analytics & Continuous Improvement

Overview:

Director, Workers’ Compensation Claims Operations – Operational Analytics & Continuous Improvement

 

Role Summary:

 

The Director, Workers’ Compensation Claims Operations is responsible for delivering timely, actionable business insights that surface and document operational issues and opportunities through real-time reporting, structured analysis, and coordinated field/SME input. The role translates those insights into rapid operational solutions by orchestrating multi-disciplinary actions across key spend categories, driving disciplined follow-up, and tracking completion, outcomes, and impact with clear reporting to leadership. In parallel, the Director ensures the design and delivery of operational tools, resources, and processes are aligned with IT, Claims Analytics/Reporting, Shared Services, Product, and Data Science – scaling enterprise-ready capabilities and enabling self-service data at the strategic, operational, and tactical levels.

 

Responsibilities:

 

• Build and maintain real-time operational reporting to uncover trends, emerging risks, and performance opportunities across Workers’ Compensation Claims Operations and Managed Care.
• Design repeatable mechanisms that leverage field leaders and subject matter experts to interpret insights, validate hypotheses, and clearly explain root causes and key performance drivers; memorialize insights, key findings, and agreed-upon actions, and track action completion and impact across key spend categories.
• Support operations and claim leadership in exploring business problems and solutioning; lead cross-functional problem solving by developing practical tools, resources, and standard work that improve operational effectiveness, efficiency, and consistency.
• Package and communicate operational business insights (context, definitions, methodology, and key assumptions) to Claims Analytics for deeper enterprise-level analysis and broader insights, as needed.
• Continuously seek opportunities to collaborate with Claims Analytics and Reporting to replicate and scale operational reporting with stronger enterprise capabilities – standing up immediate, fit-for-purpose tools when needed while providing a clear blueprint of requirements to enable robust self-service data at the strategic, operational, and tactical levels.
• Support leadership in strengthening enterprise alignment and operational readiness by maintaining visibility to cross-functional initiatives (e.g., IT, Shared Services, Product, and Data Science) that materially impact Workers’ Compensation Claims Operations through an integrated roadmap (scope, owners, timelines, dependencies, and expected impact).
• Partner closely with Analytics, Reporting, and Shared Services to understand dependencies and improve operating rhythm; develop and communicate clear business requirements for work requests and enable enterprise analytics and reporting teams to better understand managed care data so they can build tools and resources that support data-driven decisions.
• Identify opportunities for automation and self-service; develop and implement solutions that streamline work, reduce manual effort, and improve quality and turnaround times; build mechanisms to track and report the impact of improvements.
• Partner with key stakeholders to design and implement AI-driven technologies tailored to Workers’ Compensation technical and operational needs – enhancing speed and quality of service delivery and making work easier for adjusters, while establishing best-in-class confidence in both AI outputs and the mechanisms that ensure qualified human judgment, action, and decisioning are applied appropriately.
• Source and develop talent to expand and diversify operational support capabilities for the managed care organization and broader claims organization.

 

Qualifications:

 

Core Competencies:

 

• Operational analytics and insight generation (trend detection, KPI design, and performance management)
• Operational root-cause analysis and structured problem solving (hypothesis-driven, field/SME-enabled)
• Process optimization and continuous improvement (standard work, simplification, waste elimination)
• Cross-functional support, partnership and influence (Analytics, Reporting, Shared Services, and operations leaders)
• Automation mindset and enablement (workflow redesign, self-service tools, reduction of manual steps)
• People leadership and talent development (coaching, capability building, succession planning)
• Business requirements definition and solution governance (risk, compliance, and downstream impact assessment – ensuring AI-enabled capabilities are aligned to the claims organization’s needs and priorities)