VP, Claims Operations

Why choose Palomar?

Palomar is a rapidly growing and innovative insurer focused on providing specialty insurance to residential and commercial customers. Palomar welcomes the best and brightest to our thriving team. Guided by an entrepreneurial spirit, Palomar is building a dynamic and diverse team.

Join a company built on a culture of agility, innovation and authenticity that delivers peace of mind and protection to individuals and businesses impacted by adversity.

Want to learn more about our exciting journey? https://ir.plmr.com/corporate-profile/default.aspx

We are Hiring!

Location: La Jolla, CA; Edina, MN; Remote

The Details:

We are seeking a strategic and hands-on Vice President, Claims Operations to join our specialty property and casualty insurance claims leadership team. This executive will strengthen claims operating discipline by building key performance indicator driven reporting, defining claims analytics requirements, and leading internal and third-party administrator file review/quality assurance programs. The Vice President will translate operational insight into meaningful process improvement, stronger vendor accountability, and scalable claims excellence - improving consistency, compliance, reserving discipline, and overall claim outcomes.

What will you do:

• Drive claims operations performance by governing and benchmarking TPAs, strengthening vendor accountability, and translating analytics into clear operational and financial strategy.
• Build and lead KPI-driven reporting by defining analytical requirements and tracking claims KPIs, dashboards, and metrics to measure effectiveness and drive continuous improvement.
• Partner with TPAs on corrective actions to address performance gaps, emerging trends, and control issues.
• Establish a formal TPA governance and Quality Assurance program - scorecards, performance reviews, operating cadence/escalations, and standardized file review criteria, scoring, and reporting - to ensure consistent claims quality.
• Conduct regular operational reviews with TPAs to evaluate results against service expectations, contractual standards, KPIs, and claim-handling requirements.
• Lead internal and TPA claims file reviews to assess handling quality and discipline, including coverage analysis, investigations, reserving, documentation, litigation and vendor management, and compliance with company standards.

What we are looking for:

• 10+ years of progressive claims experience, preferably within an insurer overseeing TPAs in Property & Casualty lines. Experience with Specialty lines of business is a plus.
• Bachelor's degree required.
• Strong knowledge of claims processes, regulatory compliance, and industry best practices.
• Deep understanding of claims life cycle, reserving practices, LAE drivers, and claims financial metrics.
• Experience defining analytical requirements for claims-related reports, KPIs and metrics to drive operational performance.
• Experience designing and conducting TPA or claims file reviews, or quality assurance assessments across internal claim teams and/or TPAs.
• Strong analytical skills with the ability to translate data into operational and financial strategy.
• Excellent negotiation, communication, and executive presentation skills.
• Proficiency in claims management systems and data reporting tools.

We love people who want to: 

• Build strong relationships through transparency, trust, and respect for each other.
• Work in an agile environment, with a resilient mindset to find creative solutions to challenges.
• Collaborate and celebrate diverse perspectives, promoting inclusivity and equality.
• Do the right thing with strong conviction and integrity.
• Be bold and innovative to help make an impact.
• Demonstrable track record of working autonomously and driving progress
• Be intellectually curious, think creatively, and pragmatic

If you thrive in a dynamic environment, and like working with happy, authentic, talented people, you'll enjoy a career with Palomar!