- Design and update claims workflows across onboarding, client relationships, carriers, vendors, legal, estimating and contents.
- Configure workflow stages, handoffs, triggers and SLA timers from signing through settlement.
- Design and maintain file audits, including 45-day file audits, submission timing, call and email logging, and file handling.
- Track submissions, collections, cycle time, caseload by adjuster tier and audit scores.
- Build automated scorecards and dashboards for the department, each pod and each adjuster.
- Combine data from Claimore and other systems into a single view, keeping Claimore as the source of truth.
- Own the Claimore roadmap and backlog, prioritize requirements, coordinate releases and review vendor invoices against delivered work.
- Build dashboards, automated audits and reports using AI tools, Power BI and Excel; maintain the Claude-based Claims AI knowledge base.
- Run weekly reviews with the Director of Claims and Chief Growth Officer, and review SOPs for steps the system cannot track.
- Shadow teams on site quarterly and, as the function grows, hire and lead operations managers for new pods.
SQLMicrosoft Power BIMicrosoft Excel