VP, Claims Operations

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! What will you get in return? Full Suite of Medical Benefits Long Term Financial Incentives – STOCK! 401k with 3.5% Automatic Fully Vested Employer Contributions Competitive PTO + Holiday Program Lifestyle Spending Allowance Professional Development Assistance Career Exploration Opportunities Regular company-wide social events (even virtually!) To learn more visit us at www.plmr.com Diversity at Palomar At Palomar, we are committed to diversity, equality and inclusion in all facets of the organization. We have built an open culture that celebrates the diversity of our workforce, while actively championing equality and inclusion practices that make us a company people want to work with and work for. We believe that diversity, equality and inclusion yields greater organizational creativity and productivity, which helps us serve our customers and partners more effectively. Delivering on our diversity commitment returns greater value to our shareholders and ultimately makes a positive impact to the communities in which we do business and to the people who live in them #PalomarPride #Insurancejobs #hiring Accommodations: Palomar will consider reasonable accommodations to ensure a qualified applicant with a disability can be considered for the position. Palomar will also consider necessary modifications to the physical work environment, or to the way a job is usually performed, so an individual with a disability can perform the essential functions of the position. Additional accommodations will be considered that enable an employee with a disability to enjoy equal benefits and privileges of employment like those that are enjoyed by other employees without disabilities. For more information about our company, visit us at www.plmr.com. Palomar is an Equal Opportunity Employer. No phone calls or agency solicitation please CCPA Job Applicant: Pay Range: $$150,000 - $215,000 + Bonus Potential & Participation in our Competitive Long-Term Incentive (LTI) Program. The above pay range is for all US-based roles based on function and level, benchmarked against companies of similar size and scope. To be compliant with local legislation as well as provide greater transparency to candidates, we disclose salary ranges on all job postings regardless of the desired job location. We also offer a competitive annual discretionary bonus program and the opportunity for annual long-term incentive stock grants. In addition, we offer a highly competitive benefits package. Final offer amounts are determined by multiple factors, including candidate experience and qualifications, and may vary from the amounts listed above