Claims Director

TITLE:                                      Director, Claims

FLSA:                                       Exempt, Full Time

DEPARTMENT:                    Claims

WORKSITE:                           6 West Colony Place, Durham, NC

REPORTS TO:                       EVP, Insurance Operations

OCCUPATIONALSUMMARY:

Responsible for the strategic leadership, operational management, and oversight of the organization’s claims department. This role ensures timely, accurate, and compliant claims handling while promoting exceptional customer service, effective risk management, and continuous operational improvement. The Director of Claims leads claims staff, develops departmental processes and performance standards, manages complex and escalated claims matters, and collaborates with internal and external stakeholders to support organizational objectives.

DUTIES/RESPONSIBILITIES:

• Lead and inspire a service-focused team.


• Oversee the intake, investigation, evaluation, reserving, and resolution of claims.


• Ensure claims are handled in accordance with policy provisions, company guidelines, regulatory requirements, and industry standards.


• Manage complex, high exposure, litigated, or escalated claims


• Review and approve significant coverage determinations, settlement authority, and denial recommendations where applicable.


• Develop and implement claims handling strategies, workflows, and best practices.


• Establish department goals, KPIs, and performance standards.


• Oversee quality assurance and audit processes for claims handling activities.


• Identify operational, legal, and financial risks within the claims process and implement corrective actions.


• Assist in the development and implementation of reservation of rights letters, coverage position letters, and claims procedures.


• Monitor claim reserves, loss trends, and financial exposure.


• Assist with budgeting and forecasting related to claims operations.


• Ensure appropriate expense management and vendor performance standards.


• Maintain positive relationships with insureds, brokers, members, partners, and external stakeholders.


• Collaborate cross-functionally with underwriting, operations, finance, and customer service teams.


• Provide claims reporting and operational updates to executive leadership.


• Other duties as assigned.

EDUCATION

• Bachelor’s degree or equivalent experience required


• 10+ years of relevant claims experience


• 2+ years leadership within a claims management role


• Valid adjusters license or ability to obtain such

REQUIRED KNOWLEDGE, SKILLS & ABILITIES

• Knowledge of the scuba diving industry


• Deep knowledge and experience with captive insurance companies, risk retention groups, accident and health and trip/travel programs


• Knowledge of Trip/Travel Insurance


• Excellent interpersonal communication, organization, and management skills


• Superior project management skills with proven ability to plan, lead and track projects from concept through implementation


• Ability to manage timelines and milestones to ensure timely reporting and closures


• Self-motivated with strong attention to details and problem-solving skills


• Proficient with Microsoft Office Suite and experienced or adaptable to claims management platforms

Hybrid work arrangement is available with this role, 2 days remote and 3 days in office, post the 90-day probationary period.