Claims Governance Leader, Employee Benefits (HYBRID or REMOTE

Primary Location Other Locations Organization Organization :
Equitable Schedule Schedule :
Full-time

About the Role

At Equitable, we help clients secure their financial well-being so they can pursue long and fulfilling lives- a missionwe’vehoned since 1859.

Equitable is looking for an influential and dynamic leader to join our team! The Claims Governance will own and lead critical aspects of our Employee Benefits Claims organization, including Quality Assurance, Vendor/TPA Engagements, Inventory Management, Capacity Models, Controls,Training, and Policies and Procedures. Reporting directly to the Head of Claims, this role is pivotal in ensuring efficient and effective processing of claims, compliance with regulatory standards, and meeting the diverse needs of our clients.

This individual must be able to translate Employee Benefits’ “Powerfully Simple” vision into actionable, quantitative, and innovative plans, including leading the design, ideation and build of a Claims Governanceframework for Employee Benefit Claims.

This position offers a flexible work schedule: it may be fully remote/hybrid. If youarelocatednear one of our offices (e.g., Charlotte, NC; New York, NY; Syracuse, NY), a hybrid schedule with 2–3 days on-site per week is expected to foster collaboration and connection.

Responsibilities

Creates and executes on Employee Benefit’s Claims Excellence and Governance strategy, including ownership for Quality, Training, Vendor/TPA Engagements, and Policies & Procedures.

Ensures the timely deployment of talent and processes in support of both the initial build/implementation of the EB Claims Governance organization and ongoing execution of the strategy.

Responsible for creating a strategic approach to setting, monitoring and executing key performance indicators to drive a positive customer experience.

Responsible for overseeing the quality assurance of claims processing, ensuring accuracy, timeliness, and compliance with policies and regulations.

Responsible for oversight of new and existing TPA and vendor engagements/relationships, ensuring they meet contractual obligations and service level agreements (SLAs).

Oversees the design, development, and execution of an EB Claims training program, encompassing both new hire training and ongoing learning and development needs.

Leads a robust policies and procedures framework, to ensure processes and expectations are clearly defined, well-documented, and accessible to all applicable parties.

Leads and manages a robust organization, including attracting and retaining top industry talent and fostering a culture of collaboration, innovation, and continuous improvement.

Collaborates with internal departments, external partners, and other key stakeholders to execute a market-leading strategy.

Performs other duties as assigned.

The base salary range for this position is $145,000 - $170,000
. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends onleveland functional area of responsibility.

For eligible employees, Equitableprovidesa full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, pleasereferencethe link below.

10+ years of experience in Employee Benefits or Group Insurance Claims

5+ years of people leadership experience with excellent team management abilities

Professional work experience with one or more of the following Claims functions:
Quality Assurance, Training, Vendor/TPA Engagements, Inventory Management, Compliance and Policies/Procedures

Preferred Qualifications

Strong analytical, strategic thinking and problem-solving skills

Strong understanding of technology and industry trends

Proven track record of innovative problem solving

Strong verbal, written communication, and presentation skills

Comfortable dealing with complexity and ambiguity and able to explore multiple solutions

Strategic visionary who develops,…