Claims Communication and Process Enablement Lead

WORKFLOW DOCUMENTATION AND STANDARDIZATION

Owns end-to-end documentation of critical Claims workflows across Adjusting, Medical Management, and operational support functions.

Translates complex workflows into clear, structured process maps and execution standards.

Establishes and enforces documentation standards to ensure consistency across all Claims functions.

Ensures the integrity and ongoing accuracy of a centralized repository for Claims workflows, updating documentation as processes evolve.

JOB AIDS AND PRACTICAL ENABLEMENT

Designs and delivers high-quality job aids that support real-time decision making.

Ensures materials are usable in the flow of work, reducing reliance on tribal knowledge or inconsistent practices.

Continuously refines tools based on frontline feedback and observed execution gaps.

CHANGE COMMUNICATION AND ADOPTION DISCIPLINE

Partners with Claims leadership and Transformation team to translate system changes and process updates into clear, actionable communications.

Ensures a singular, consistent voice across all Claims communication related to workflow and execution changes.

Establishes a repeatable model for change rollout, including sequencing, reinforcement, and adoption tracking.

Identifies breakdowns in adoption and drives correction actions.

EXECUTION QUALITY AND CONTINUOUS IMPROVEMENT

Monitors execution consistency across teams and identifies gaps between defined standards and actual practice.

Utilizes data, audits, and frontline feedback to prioritize improvements.

Drives continuous refinement of workflows, job aids, and communication practices

QUALIFICATIONS:

EDUCATION

Bachelor's degree from an accredited four-year college or university.

LICENSES AND CERTIFICATIONS: One or more preferred

Licensed to adjust workers compensation claims in one or more jurisdictions.

Prosci Change Management Certification or Certified Change Management Professional (CCMP).

Project Management Professional (PMP).

EXPERIENCE

A minimum of seven (7) years of experience in workers compensation claims management, claims operations, or closely related functions.

Demonstrated experience translating complex processes into clear, structured, and actionable guidance.

Proven experience with Claims Management Systems (CMS).

Experience supporting or leading operational change initiatives, including system implementations or workflow designs; experience driving adoption, not just awareness.

TECHNICAL KNOWLEDGE/SKILLS

Deep understanding of end-to-end Claims workflows, including Adjusting, Medical Management, and regulatory considerations.

Strong process orientation with ability to simplify complexity without losing substance.

Ability to convert strategy and system design into practical execution.

Strong ability to influence without direct authority across multiple levels of the organization.

Proven ability to bring structure, discipline, and clarity to ambiguous or evolving environments.

Demonstrated proficiency in Microsoft Office suite of applications, Power BI, and currently adopted proprietary and vendor software programs.

Ability to master and become proficient in additional proprietary and vendor software programs.

CRITIAL THINKING

Ability to think critically and adapt quickly in a flexible and dynamic environment. Proactive and inquisitive approach to work. Ability to derive appropriate conclusions from data and various sources and apply effectively.

LANGUAGE ABILITY

Ability to read, analyze, and interpret Claims laws and regulations, medical documentation, general business periodicals, professional journals, technical procedures, and data from various sources. Ability to develop clear, actionable workflows/SOPs maintaining strict adherence to regulations, and effectively communicate them to stakeholders/users both in individual conversations and presentations to groups. Ability to write effective business correspondence and clear, concise procedures. Makes persuasive arguments.

MATH AND REASONING ABILITY

Ability to solve practical problems and deal with a variety of variables in situations where only limited standardization exists. Ability to interpret instructions furnished in written, oral, diagram, or schedule form. Ability to derive appropriate conclusions and apply on the job.

WHAT WE OFFER

Hybrid Work Schedule (up to 2 days work from home upon eligibility)

Paid Time Off

Paid Holidays

Immediate Vesting of Retirement Savings + Company Match

Group Health Insurance (Medical, Dental, and Vision)

Life and AD&D Insurance

Long Term Disability Insurance

Hospital Indemnity Insurance

Accident and Critical Illness Insurance

Flexible Savings Accounts

Paid Community Volunteer Day

Employee Assistance Program

Tuition Reimbursement Program

Employee Referral Program

Diversity, Equity and Inclusion Program