Claims Transformation & Operations - Insurance - up to 1.2m

Our client is one of the leading insurance firms focusing on advancing healthcare and insurance through smarter processes and digital innovation. \This role is ideal for someone who enjoys solving complex problems, improving operations, and working across both business and technology teams.

You will act as a connector between business users, technical teams, and external parties, helping turn ideas and requirements into practical solutions that improve how claims are processed and managed.

Key Areas of Responsibility
Driving Operational Improvement

• Identify gaps and inefficiencies in current claims operations and implement improvements
• Simplify processes and introduce automation to reduce manual work
• Improve processing accuracy and turnaround time
• Monitor performance and track outcomes using key metrics

Enabling Digital & Data Solutions

• Work with technology teams to roll out system enhancements and digital tools
• Support the use of data and analytics to improve decision-making in claims
• Contribute to initiatives involving automation, AI, or predictive modelling
• Stay informed on new tools and solutions that can improve operations

Optimising Claims Processes

• Review and enhance the full claim's lifecycle, from submission to settlement
• Standardise processes and ensure alignment with internal policies and external requirements
• Continuously refine workflows to improve efficiency and control

Collaboration & Communication

• Partner with teams across functions such as underwriting, customer service, and provider relations
• Translate operational needs into clear requirements for system or process changes
• Work with external stakeholders, including healthcare providers and regulators, where needed
• Ensure alignment between business goals and operational execution

Supporting Change Initiatives

• Help introduce new systems, tools, and ways of working
• Support teams through transitions with training and clear communication
• Monitor adoption and address any issues during implementation
• Recommend improvements based on feedback and performance data

Risk & Control

• Support efforts to detect and prevent fraud and misuse
• Work with relevant teams to strengthen controls and monitoring processes
• Help improve audit approaches and ensure proper tracking of outcomes

Provider & Network Coordination

• Work with teams managing healthcare providers to improve operational workflows
• Ensure agreements and requirements are reflected in day-to-day processes
• Identify risks and opportunities to improve value and cost management

Requirements:

• Solid experience in insurance, healthcare, or claims-related roles (typically 7+ years)
• Exposure to operations improvement, transformation projects, or process redesign
• Familiarity with claims systems, workflows, or healthcare operations
• Experience working with data, automation, or digital tools is an advantage
• Consulting or project-based experience is a plus

Skills & Attributes

• Strong understanding of operational processes and problem-solving
• Ability to work across teams and manage multiple stakeholders
• Comfortable working with both business and technical teams
• Data-driven mindset with attention to detail
• Adaptable and able to perform in a fast-moving environment
• Focused on delivering practical, results-oriented solutions
• Curious and open to learning new approaches and technologies

If you're interested in this role, click 'apply now' to forward an up-to-date copy of your CV, or call us now.

If this job isn't quite right for you, but you are looking for a new position, please contact us for a confidential discussion on your career.