Responsibilities
About the Opportunity
Provide end-to-end leadership and strategic guidance for Fulfilment practice, including Life & Disability Claims, Dental Claims, and Provider Network Servicing operations. Ensure claims adjudication and provider network servicing are handled accurately, promptly, and fully aligned with policy provisions and relevant state and federal regulations. Promote operational excellence through people leadership, collaboration with partners, risk management, innovation, automation, and ongoing process enhancement while delivering outstanding customer and provider experience.
What You'll Do
- Direction of Fulfilment practice (Life & DI, Dental Claims, and Provider Network Servicing (PNS or equivalent experience) operations), guaranteeing steady attainment of service level agreements, quality standards, cost objectives, and adherence to regulations. Convert organizational and client strategies into actionable operational plans while upholding robust governance and audit preparedness throughout all areas.
- Coordinate end-to-end service delivery including workforce planning, capacity management, efficiency optimization, and quality governance. Review performance metrics and dashboards, identify gaps, and drive corrective and preventive action plans to ensure sustained operational excellence.
- Lead collaborator engagement and business growth initiatives, including new migrations, process expansions, and transitions. Act as the primary point of contact for complex, high-impact claims, provider disputes, and customer concerns, ensuring timely resolution and partner happiness.
- Lead talent growth efforts, emphasizing skill enhancement, succession readiness, and preparing leaders. Cultivate a culture of high achievement based on ongoing improvement, creativity, automation, and embracing digital technologies like RPA and analytics.
- Provide governance and technical oversight on claims processing, adjudication and provider servicing, including interpretation of policy provisions, benefit structures, medical and dental documentation and network servicing standards. Ensure consistent application of guidelines, regulatory compliance, and standard methodologies across teams.
Qualifications
Who You Are
Bachelor's or Master's degree or equivalent experience. Minimum 10–12 years of experience in insurance operations with significant involvement in life / group / health claims, including 5+ years in leadership roles. Strong knowledge of regulatory and operational requirements as well as collaborator management. Excellent communication, analytical, and leadership skills. Proficiency in MS Office and reporting tools.
- Possession of a Bachelor's or Master's degree.
- Minimum of 10-12 years experience in back office. Insurance - Domestic Insurers / US, background in Claims processing of Health Insurance / Life and disability claims/ Underwriting experience preferred.
- Proficient MS Office, written and verbal communication skills.
Additional Information
Why Choose Principal
At Principal, we believe in nurturing talent and providing a collaborative environment where you can thrive. We offer:
- Opportunities to work on brand new technologies and innovative projects.
- An encouraging and inclusive culture that values diversity.
- Continuous learning and development programs to help you achieve your career goals.
- Competitive compensation and benefits.
Join us and be part of a team that pursues outstanding quality and aims to provide world-class solutions. Your contributions will directly influence our success and help us remain leaders in the financial services industry. We are excited to see the outstanding work you will achieve with us!
