Head of Claims

HEAD OF CLAIMS

A leading organisation is seeking a Head of Claims to provide strategic direction and operational management for its claims function. This pivotal role offers you the opportunity to shape the future of claims processing, ensuring accuracy, compliance, and exceptional service delivery across medical, healthcare, and insurance claims. You will be empowered to drive process improvements, cha mpion digital transformation, and foster a culture of continuous improvement within a supportive environment that values collaboration and professional growth. The organisation is committed to nurturing talent through flexible working opportunities, generous pension contributions, and ongoing training initiatives, making this an ideal position for those who thrive in inclusive and knowledge-sharing workplaces.

* Take ownership of the end-to-end claims lifecycle, from intake to payment processing, appeals, and provider reimbursements, ensuring timely and compliant outcomes for members and stakeholders.
* Lead a high-performing team with a focus on employee engagement, succession planning, and talent development while fostering a customer-centric culture that prioritises quality and satisfaction.
* Drive operational excellence by implementing process improvements, leveraging data analytics and technology solutions, and strengthening fraud detection controls to optimise claims costs and regulatory compliance.

What you'll do:

As Head of Claims you will play a central role in shaping the organisation’s approach to medical claim processing. Your day-to-day responsibilities will involve overseeing every aspect of the claims lifecycle—from intake through adjudication to payment—ensuring that each step meets rigorous standards for timeliness and compliance. You will be instrumental in developing strategies that not only meet but exceed organisational goals by monitoring KPIs and SLAs. Your expertise will be called upon during audits as you act as the main liaison for regulatory matters. By collaborating across departments such as Finance and Medical Management you’ll help optimise outcomes while supporting strategic planning efforts. You’ll also lead process improvement projects designed to boost accuracy and customer satisfaction using advanced analytics tools. Fraud prevention will be another key area where your skills are needed as you work closely with legal teams on complex cases. Building strong relationships with providers and stakeholders is essential as you manage escalated complaints professionally. Finally your leadership will inspire your team through mentoring programmes focused on engagement talent development succession planning—all within a culture that values inclusivity flexibility ongoing learning.

* Oversee the entire claims operations function including intake, adjudication, payment processing, appeals management, and provider reimbursements to ensure seamless workflow and outstanding service.
* Develop and execute comprehensive claims management strategies that align with organisational objectives while monitoring key performance indicators (KPIs), service level agreements (SLAs), and operational targets.
* Ensure all claims processing activities comply with healthcare regulations, insurance standards, company policies, and contractual obligations by developing robust policies, procedures, and controls.
* Act as the primary point of contact for internal and external audits related to claims operations while managing compliance with applicable healthcare and insurance regulatory requirements.
* Monitor claims expenditures closely to identify opportunities for cost containment and operational efficiencies; analyse trends, utilisation patterns, and financial performance metrics for strategic decision-making.
* Collaborate with Finance, Actuarial, Medical Management, Provider Relations teams to optimise claims outcomes; support budgeting, forecasting, and strategic planning activities.
* Drive process improvement initiatives aimed at enhancing claims accuracy, productivity, customer satisfaction; implement quality assurance frameworks and regular audit programmes.
* Leverage data analytics and technology solutions to improve claims processing performance; champion automation and digital transformation initiatives within the claims function.
* Develop strong controls for identifying and preventing fraudulent or abusive claims activities; collaborate with Legal, Compliance, Risk, Special Investigations teams on suspected fraud cases.
* Build lasting relationships with healthcare providers, third-party administrators, regulators, internal stakeholders; manage escalated member/provider complaints related to claims processing; present operational performance insights to senior leadership.
* Lead, mentor, develop claims management teams; foster a high-performance culture focused on customer experience; establish succession planning/talent development initiatives; drive employee engagement/performance management programmes.

What you bring:

The Head of Claims role requires proven experience in large-scale claim operations combined with deep industry knowledge spanning medical adjudication provider reimbursement regulatory compliance fraud prevention quality assurance. Your academic background should include at minimum a bachelor’s degree preferably complemented by postgraduate qualifications or certifications relevant to business healthcare insurance finance or medical technology fields. Demonstrating over ten years’ progressive responsibility—including at least five years at senior leadership level—you bring insight into managing teams through transformation projects process improvements operational excellence initiatives. Your financial acumen enables effective cost management trend analysis strategic planning while your proficiency with analytics tools supports data-driven decision-making. Interpersonal skills are vital as you connect with stakeholders providers regulators internal colleagues presenting recommendations resolving escalated issues fostering collaborative relationships. Strategic thinking problem-solving adaptability underpin your ability to deliver results maintain compliance drive innovation nurture talent within an inclusive supportive environment.

What sets this company apart:

This organisation stands out for its unwavering commitment to delivering exceptional service while fostering an environment where employees feel valued supported empowered. With flexible working opportunities generous pension contributions ongoing training programmes it invests heavily in personal professional growth ensuring every team member has access to resources needed for advancement. The workplace culture emphasises inclusivity collaboration knowledge-sharing—creating space where ideas flourish talents are nurtured achievements celebrated collectively. Leadership here is supportive focusing on growth development rather than hierarchy enabling individuals at all levels to contribute meaningfully learn continuously progress confidently. Employees benefit from clear pathways for career progression robust engagement initiatives regular feedback mechanisms—all designed around principles of respect empathy teamwork shared purpose. By joining this organisation you become part of a network dedicated not only to operational excellence but also communal well-being mutual success long-term fulfilment.

What's next:

If you are ready to take your career further by leading transformative change in healthcare claim operations apply now!

Apply today by clicking on the link provided.

Due to the high volume of applications we are experiencing, our team will only be in touch with you if your application is shortlisted.