A Claims Operations Manager job description lays out the duties of the person in charge of the entire claims journey, from the moment a claim is filed until it’s settled. This role is absolutely essential for keeping things running smoothly, staying on the right side of regulations, and leading a team of specialists to get customers the right outcomes, fast.

Your Definitive Claims Operations Manager Job Description Template

Writing a great job description is your first, and maybe most important, step in finding a top-notch candidate. A clear, well-written post does more than just list tasks; it tells a story about your company and what you stand for. For a Claims Operations Manager, you’re looking for a unique blend of strategic thinker, inspiring leader, and process guru.

I’ve put together this template to be both thorough and flexible. You can easily tweak it to fit your company’s specific needs, whether you're a fast-moving insurtech or a well-established carrier. It gives candidates a solid picture of the job, so they know exactly what they’d be getting into and the impact they could make.

Claims Operations Manager Role at a Glance

Before we jump into the full job description, this quick-reference table breaks down the role's most important parts. It’s a handy way to get a feel for the position and see if your top candidates line up with what you really need.

This table helps you zero in on what truly matters: leading the team, understanding the data, and hitting key targets that drive the business forward.

Ready-to-Use Job Description Template

Job Title: Claims Operations Manager Department: Claims/Operations Location: [City, State / Remote] Reports To: [Director of Operations / VP of Claims]

Job Summary

We're looking for an experienced, data-savvy Claims Operations Manager to take the helm of our claims department. The person we hire will own the entire claims lifecycle, find ways to make our processes more efficient, and coach a team of claims professionals. You'll be central to creating strategies that shorten claim processing times, keep us compliant, and make our customers happy. This is a leadership role for someone with sharp analytical skills and a solid grasp of modern claims management.

Key Responsibilities

• Run the day-to-day operations of the claims team, making sure all claims are handled accurately and on time from first notice to final resolution.

• Create, implement, and constantly improve our standard operating procedures (SOPs) to make workflows smoother and more effective.

• Keep a close eye on key performance indicators (KPIs) like claim cycle time, accuracy rates, and customer satisfaction scores, and share regular progress reports with senior leadership.

• Lead, mentor, and grow a high-performing team of claims specialists through consistent coaching, performance reviews, and career development.

• Make sure all our claims handling practices follow industry regulations and our own internal compliance rules.

• Dig into claims data to spot trends, find areas for improvement, and use that insight to reduce risks and lower costs.

• Work closely with other teams—like Underwriting, Legal, and Customer Service—to ensure our entire claims process is seamless and collaborative.

Required Qualifications

• Bachelor’s degree in Business Administration, Finance, or a related field.

• 5+ years of experience in claims management or operations, with at least 2 years in a leadership or supervisory role.

• Hands-on experience with claims management software and data analysis tools (e.g., Tableau, SQL).

• Deep knowledge of insurance industry regulations and compliance requirements.

• Exceptional leadership, communication, and problem-solving skills.

Core Responsibilities and Daily Functions

The Claims Operations Manager is the engine of the claims department. It’s a dynamic role that juggles hands-on process management, big-picture strategic planning, and, most importantly, people leadership. They're the ones responsible for making sure every claim moves smoothly from the first notice of loss to a fair and timely resolution.

A typical day is a balancing act between these three core areas. A well-written Claims Operations Manager job description will always reflect this mix of tactical work and strategic oversight, showing just how critical the role is to the company's success.

Operational and Process Management

At its heart, this job is about keeping the entire claims lifecycle running like a well-oiled machine. This means creating and constantly refining the standard operating procedures (SOPs) that dictate how every claim is handled, from intake and verification all the way through to investigation and payment.

Key duties in this area usually include:

• Overseeing Claim Adjudication: This is the big one—making sure every claim is processed accurately, fairly, and strictly in line with policy terms and regulatory rules.

• Workflow Optimization: A great manager is always looking for bottlenecks. They're the ones who'll find ways to improve the process, like implementing a new digital submission portal that cuts initial data entry time by 30%.

• Vendor and Partner Management: They also manage relationships with third-party administrators (TPAs), investigators, and other external partners, holding them accountable to their service-level agreements (SLAs).

A key operational goal is to minimize claim leakage—the difference between what an insurer should have paid and what was actually paid. Effective process management directly impacts this metric, protecting the company's bottom line.

Strategic and Analytical Functions

This role isn't just about putting out fires. A Claims Operations Manager is responsible for the department's long-term health and performance. This takes a sharp analytical mind to dig into data, spot emerging trends, and make smart decisions that support the company's larger goals.

Strategic responsibilities often involve:

• Performance Monitoring: Keeping a close eye on key performance indicators (KPIs) like average claim cycle time, cost per claim, and claim accuracy rates to see how the team is doing.

• Data Analysis and Reporting: Turning raw claims data into actionable insights for senior leadership. This could mean highlighting trends in claim types, flagging potential fraud patterns, or identifying customer satisfaction issues before they escalate.

• Regulatory Compliance: The insurance world is full of rules. This manager has to stay on top of all relevant regulations to ensure the department's practices are always compliant, avoiding hefty fines and protecting the company's reputation.

Understanding how related positions function, such as the various insurance agent roles, gives a manager valuable context for their own daily responsibilities and where they fit into the bigger insurance picture.

Team Leadership and Mentorship

So much of this role comes down to leading and developing the claims team. A great manager fosters a culture of accountability, empathy, and high performance, which has a direct effect on both employee morale and the quality of customer service.

Leadership duties are a daily priority:

• Coaching and Development: They provide constant, constructive feedback and build out professional development plans for claims specialists and adjusters to help them grow their careers.

• Performance Reviews: This isn't just a once-a-year thing. It means weekly or bi-weekly check-ins and more formal quarterly reviews to set clear expectations and address any performance gaps.

• Resource Allocation: They manage team workloads, know who to assign the most complex cases to, and make sure the team has the tools and training they need to do their jobs well.

• Hiring and Onboarding: When it's time to grow the team, they lead the charge in recruiting new talent and ensuring a solid onboarding process gets them up to speed quickly.

What to Look for: Key Skills and Qualifications

When you're writing a claims operations manager job description, nailing down the right mix of skills is everything. A great candidate brings more to the table than just years in the industry. You need someone with a solid blend of technical know-how and the people skills to lead a team, make sense of complex data, and really push for operational excellence.

Breaking these skills down into "hard" and "soft" categories helps a lot. It allows you to build a clearer picture of your ideal hire—someone who can handle both the technical side and the human side of the job.

Hard Skills: The Technical and Analytical Foundation

Hard skills are the concrete, teachable abilities that are the bedrock of the role. You can measure them, and they're directly tied to the day-to-day work a Claims Operations Manager will be doing. Honestly, without these, a candidate just won't be able to run the claims department effectively.

Here are the must-haves:

• Claims Management Systems (CMS) Proficiency: This is a big one. Deep, practical experience with standard CMS platforms is non-negotiable. They need to know the system's workflows, data protocols, and reporting features inside and out to make sure the team is getting the most out of it.

• Data Analysis and Reporting: The best managers can take raw claims data and turn it into real strategy. This means they need to be comfortable with tools like SQL, Tableau, or even advanced Excel to spot trends, find bottlenecks, and create clear, compelling reports for the leadership team.

• Regulatory Knowledge: A rock-solid understanding of insurance regulations, compliance standards, and state-specific laws is absolutely critical. This isn't just about ticking boxes; it's about avoiding hefty fines and making sure every claim is handled ethically and legally.

• Financial Acumen: This person needs to be good with numbers. That includes managing the department's budget, understanding key financial metrics like loss ratios, and running cost-benefit analyses on things like new software or process updates.

Soft Skills: Leadership and Strategic Insight

If hard skills keep the engine running, soft skills are what steer the ship. These are the interpersonal and thinking skills that elevate a good manager into a great leader. It's how they inspire their team, handle tough situations, and communicate with everyone from a junior adjuster to the C-suite.

"A constant sense of urgency, empathy for our customers and detailed analytical skills. This is what it takes to grow and thrive on our Claim team." This quote really gets to the heart of it—soft skills are essential in a role that’s all about the customer.

Here are the soft skills that truly matter:

• Leadership and Mentorship: At its core, this is a leadership role. The ability to guide, motivate, and grow a team of claims specialists is paramount. This means setting clear goals, giving useful feedback, and building a culture where people want to do their best work.

• Strategic Thinking: A great manager doesn't just focus on today's to-do list; they're always looking ahead. They can anticipate future challenges, see opportunities for improvement, and make sure the department's work is directly supporting the company's bigger goals.

• Problem-Solving: Things go wrong. Whether it's a sudden spike in claims or a tricky customer issue, a manager has to be a sharp, creative problem-solver. They need to think on their feet, analyze the situation, and put effective solutions in place, often under pressure.

• Communication: Clear and direct communication is the glue that holds everything together. To truly succeed, a Claims Operations Manager must constantly work to improve business communication, ensuring clarity and strong teamwork with their own team, senior leaders, and outside partners.

Key Performance Indicators to Measure Success

What separates a good claims department from a great one? The answer often lies in the data. For a Claims Operations Manager, Key Performance Indicators (KPIs) aren’t just numbers on a screen; they are the vital signs of the department's health. Tracking these metrics gives you a clear, objective view of efficiency, quality, and the customer experience.

When you’re writing a claims operations manager job description, you need to signal that the role is deeply data-driven. The best candidates want to know they’ll be judged on specific, measurable outcomes. These KPIs become the bedrock for everything from performance reviews to strategic planning and pinpointing where processes need a tune-up.

As you can see below, a modern claims manager needs a strong mix of tech-savviness, data analysis, and old-fashioned leadership to really knock it out of the park.

This breakdown makes it clear: while technology is a huge piece of the puzzle, you can't drive real operational excellence without solid data and leadership skills backing it up.

Core Operational KPIs

These are the bread-and-butter metrics that get right to the heart of your team's efficiency and speed. They measure how quickly you can get a claim from that first phone call to a final resolution.

• Claim Processing Time (Cycle Time): This is the big one. It’s the average time it takes to get a claim from open to closed. A shorter cycle time almost always means happier customers and lower administrative costs. You calculate it as: Total days for all closed claims / Number of closed claims.

• First Contact Resolution (FCR): This KPI is gold. It tracks the percentage of claims you can completely resolve on the very first interaction with the claimant. A high FCR tells you your team is knowledgeable and your processes are sharp, which does wonders for customer satisfaction.

Quality and Accuracy Metrics

Look, speed is great, but it means nothing if the work is sloppy. These KPIs are your quality control, ensuring claims are handled correctly, payments are accurate, and you’re staying compliant. This is how you minimize expensive mistakes and claim leakage.

A seasoned manager knows that while speed is important, accuracy is everything. A single payment error can destroy a customer’s trust and cost the company a fortune—far more than you’d save by shaving a day off the cycle time.

Here are the quality metrics you absolutely have to watch:

• Claim Accuracy Rate: This is a simple but powerful measure of how many claims get processed without any errors, from data entry mistakes to payment miscalculations. The formula is: (Total claims - Claims with errors) / Total claims x 100. A high accuracy rate is a direct reflection of your team’s training and the integrity of your workflow.

• Claim Reopen Rate: This one tells you how many "closed" claims come back to life because of new information or issues that weren't fully resolved. A low reopen rate is a sign of thorough initial investigations and solid settlements.

Financial and Customer-Focused KPIs

At the end of the day, a claims department has to balance the books while keeping customers happy. These KPIs tie your team’s performance directly to business outcomes and how claimants feel about their experience.

• Cost Per Claim: This is the total cost—including staff time and overhead—to process a single claim. A huge part of any manager’s job is figuring out how to push this number down without letting quality slip.

• Customer Satisfaction (CSAT) / Net Promoter Score (NPS): These are direct lines to your customer’s mindset. CSAT surveys measure satisfaction with a specific interaction, while NPS gauges overall loyalty. For a claims team, these scores are crucial for understanding how well you’re supporting people during a really tough time.

Compensation and Salary Benchmarks for 2026

Figuring out the right compensation is always a balancing act, but it’s absolutely critical if you want to land top talent in a competitive market. For a key role like a Claims Operations Manager, a strong offer isn’t just about the base salary. It needs to reflect their direct impact on your bottom line, which often means including performance bonuses and other incentives.

Knowing the current market benchmarks is your starting point for putting together an offer that will actually get noticed.

Our claims operations manager job description needs to be backed by real-world salary data. In the world of insurance and insurtech, these managers are in demand because they directly impact efficiency and control financial leakage. Looking at job postings in early 2026, the average salary range is sitting between $93,000 and $126,000 a year in major US cities. That lines up with broader industry data, which puts the national average right around $103,293, with the highest earners pushing close to $130,000. For a deeper dive into this data, you can check out the benchmarking reports over at Comprehensive.io.

Factors Influencing Salary Ranges

Of course, compensation is never a single, flat number. A few key things can push the salary for a Claims Operations Manager up or down, and you need to account for them when you're setting your budget.

• Geographic Location: It’s no surprise that major hubs like New York, San Francisco, and Boston pay more. You can expect salaries there to be 15-20% higher than the national average to offset the cost of living and the fierce competition for talent.

• Company Stage: A large, established insurance carrier will likely offer a higher base salary and a classic benefits package. An early-stage insurtech startup, on the other hand, might offer a slightly lower base but make up for it with a hefty chunk of equity, giving the manager a real stake in the company's success.

• Industry Specialization: If you need someone with deep experience in a complex field—like commercial property, liability, or niche fintech claims—be prepared to pay for it. Specialized expertise is a premium asset.

Pro Tip: Always think in terms of total compensation, not just base salary. A solid bonus structure tied to metrics like claim accuracy or cost savings can boost total earnings by 10-25% a year. That’s often what makes an offer truly compelling.

Structuring a Competitive Offer

To build a package that will win over your ideal candidate, you need a plan. First, do your homework and see what similar companies in your area and industry are paying. Our guide on how to perform market salary research walks you through this step-by-step.

Next, map out a clear bonus structure. For this role, performance bonuses are the norm. Tie them directly to the KPIs that drive your business forward, whether that’s shortening claim cycle times or boosting customer satisfaction scores.

Finally, stay flexible. Your top candidate will likely have their own expectations. Being ready to negotiate on the base salary, equity, or even a sign-on bonus can be the deciding factor that gets them to say yes.

Career Path and Growth Opportunities

Think of the Claims Operations Manager role not as a final stop, but as a key junction in a career that can branch out in some really interesting directions, especially in insurance and tech. When you're talking to ambitious candidates, showing them what's next is a huge selling point. For companies, it's about retention—you keep your best people by showing them a clear path forward.

Most people don't just land in this role. The journey usually starts on the ground floor, maybe as a Senior Claims Adjuster or a Claims Team Lead. From there, you might move into an Associate Manager role, where you get your first taste of overseeing a small team and managing a piece of the claims process. This is where you build the muscle for the full Claims Operations Manager position, which demands a much bigger-picture view of performance, strategy, and owning processes from end to end.

From Manager to Director and Beyond

Once you've proven you can run a tight ship as a Claims Operations Manager, the doors really start to open. The path isn't always a straight line, but it consistently leads to more strategic influence and broader leadership responsibilities. Naturally, the pay reflects this growth, often scaling up significantly with each step.

You can see this trajectory clearly in the compensation data. It’s a role that rewards experience, which is why it’s so attractive to high-growth companies. For example, someone with under a year of experience might start around $61,070. After a few years (1-4), that typically bumps up to $68,032. Hit mid-career, and you're looking at over $80,000. Senior managers often clear $100,000, with the top 10% earning $119,000 or more. For a deeper dive into these numbers, Payscale.com has some great, detailed data.

A typical career ladder might look something like this:

• Senior Claims Operations Manager: In a larger company, this role means managing a bigger team or a more complex portfolio. You’re the one they tap for the heavy-lifting projects, like migrating the entire claims system or completely overhauling a core process.

• Director of Claims Operations: At the director level, you're pretty much done with the day-to-day weeds. Your focus is now on high-level strategy. You’re managing other managers, setting the department's vision for the next five years, controlling a hefty budget, and speaking for the claims department in executive meetings.

• Vice President (VP) of Claims: This is the top of the claims mountain. The VP is ultimately accountable for the entire claims organization—its performance, its profitability, and its strategic direction. They play a huge part in setting company-wide policy and pushing for real innovation across everything claims-related.

This clear upward mobility makes the claims operations manager job description much more than just a list of tasks. It's a ticket to a serious leadership career.

Tailoring the Job Description for Insurtech and Fintech

An insurtech or fintech company runs on a completely different engine than a traditional insurance carrier. While legacy firms prize stability and strict adherence to long-standing protocols, startups are all about agility, data, and fast iteration. This means your standard, off-the-shelf claims operations manager job description just won't cut it—it will almost certainly attract the wrong candidates.

To pull in talent with a tech-first mindset, you have to frame the role around innovation, not just maintenance. The words you choose need to signal a dynamic environment where the manager is expected to build and scale processes from the ground up, not just keep an existing machine running.

Highlighting a Tech-Forward Mindset

In an insurtech setting, the manager isn't simply a user of technology; they are a central figure in its implementation and continuous improvement. Your job description must make this clear by focusing on skills that live at the intersection of operations, product, and engineering. This approach attracts people who see claims not as a cost center, but as a product feature that can be relentlessly improved.

Here’s how to emphasize this modern approach in the responsibilities section:

• Collaborate with Product and Engineering: Make it explicit that the manager will work side-by-side with tech teams to design, test, and deploy new features within the claims platform.

• Drive Automation Initiatives: Position the role as a leader who actively seeks out and implements automation—think using AI for initial claims triage or sophisticated fraud detection.

• Master a Modern Tech Stack: List the specific tools you actually use, like SQL for data queries or a BI platform like Looker or Tableau, and present them as essential, everyday parts of the job.

Adapting the Job Description for a Startup Culture

The real split between a traditional firm and an insurtech startup often boils down to culture and day-to-day focus. The table below shows how to shift the emphasis in your job description to find someone who will thrive in a fast-paced environment.

Job Description Focus: Traditional vs. Insurtech

In a startup, the ideal Claims Operations Manager is a builder, not just an administrator. They're expected to write the playbook, not just follow it. This requires a ton of adaptability and a genuine desire to solve problems proactively.

This focus on building and scaling is everything. The right candidate gets energized by the challenge of creating hyper-efficient systems from scratch. As you build out your team, understanding these role nuances is critical. For a deeper dive, our guide to P&C staffing solutions offers great context for scaling your operations the right way.

Interview Questions to Identify Top Candidates

Finding a great Claims Operations Manager isn't just about what's on their resume. You need an interview process that digs into how they actually perform on the job. The right questions will show you how they solve problems, lead their teams, and apply their technical know-how in the real world. A good interview goes way beyond the basics to see how a candidate thinks and acts when the pressure is on.

This role is the nerve center of any claims department. These managers are responsible for making sure claims get processed efficiently, all while keeping a sharp eye out for fraud—which costs the U.S. insurance industry over $40 billion a year. A solid interview strategy is your best defense, ensuring you hire someone who can protect the company's bottom line while delivering for your customers. To get a sense of what the market is paying, you can review the latest market data on salaries for this role.

Behavioral Interview Questions

Behavioral questions are all about past performance. The idea is simple: the best predictor of future behavior is past behavior. You're asking candidates to pull specific examples from their work history, which gives you solid proof of their skills.

• "Describe a time you used data to find a bottleneck in the claims process. What was the outcome?"

  • What to look for: A strong answer will get specific. They should talk about the exact metrics they tracked (like claim cycle time or cost per claim), the tools they used to analyze the data, and the tangible, measurable improvements that came from their actions.

• "Tell me about a difficult coaching conversation you had with a team member. How did you handle it?"

  • What to look for: You're listening for a mix of empathy and directness. The best leaders focus on constructive feedback and development, not just placing blame. They see these moments as opportunities to help someone grow.

For a more in-depth look at this style of interviewing, our guide on behavioral interview questions with sample answers is a great resource.

Situational and Technical Questions

These questions are designed to test a candidate's ability to think on their feet. You're giving them hypothetical—but very realistic—scenarios to see how they'd apply their expertise.

• "Imagine your department gets hit with a 50% surge in claim volume overnight because of a natural disaster. What are your first three steps?"

  • What to look for: A top-tier candidate will immediately lay out a logical plan. It should cover reallocating resources, communicating clearly with the team, and figuring out how to maintain service levels during a crisis.

• "How would you go about evaluating and implementing new claims management software?"

  • What to look for: The answer should be a mini-project plan. A great candidate will talk through the key phases: starting with a needs analysis, getting buy-in from stakeholders, managing the vendor relationship, and planning for training and data migration.

Common Questions About the Claims Operations Manager Role

Even the most detailed job description can leave some questions unanswered. Let's dig into some of the most common things candidates and hiring managers ask about what it really takes to succeed as a Claims Operations Manager.

Think of this as the conversation that happens after you've read the job spec. We'll cover the real-world challenges, the tech that's changing the game, and what truly makes someone ready for a leadership position in claims.

What's the Single Biggest Challenge in This Job?

Honestly, it's the constant juggling act between three critical, and often conflicting, goals: speed, accuracy, and customer satisfaction. You're always under pressure to settle claims fast—it keeps customers happy and helps manage costs. But if you move too fast, you risk making mistakes, which leads to expensive claim leakage.

On top of that, you have to make sure every single decision is fair, ethical, and by the book from a compliance standpoint. It creates a high-stakes environment where you’re not just managing a team; you're coaching them to make smart, empathetic decisions under pressure.

How Is Technology Changing Claims Management?

Technology isn't just a part of the job anymore; it's completely reshaping it. A few years ago, this role was mostly about managing people and processes. Now, it's about integrating smart tools to build a more efficient, data-backed operation.

Here are a few ways tech is making a huge impact:

• Automated Triage: AI can handle the initial intake and sorting of claims, which lets your experienced adjusters focus their brainpower on the really complex cases.

• Predictive Analytics: We can now use sophisticated algorithms to flag claims that look suspicious, catching potential fraud with far more precision than the human eye alone.

• Better Customer Experience: Tools like chatbots and self-service portals mean claimants can check their claim status whenever they want, 24/7. This transparency goes a long way in reducing frustration and improving satisfaction.

A modern Claims Operations Manager has to be a tech advocate. Your ability to spot the right tools, get them implemented, and guide your team through the change is what separates a good manager from a great one today.

What Qualifications Really Matter for a Leadership Role?

Having a solid background in claims is table stakes, of course. But the skills that get you promoted into management are less about your own technical claims-handling ability and more about your strategic impact. If you're looking to move up, you need to show you can lead.

Focus on building a track record in a few key areas: mentoring and developing a team, using data to make smart decisions, and managing projects successfully. Being able to point to specific examples—like how you coached a junior adjuster to success, used KPIs to fix a broken process, or led the rollout of new software—is what will make you a standout candidate.

Finding the right leader for your claims department is tough, but it doesn't have to be slow. JobCompass.ai combines AI sourcing with expert human vetting to deliver a shortlist of top-tier, pre-screened candidates in just 48 hours, so you can hire faster and with more confidence.