VP, Claims - Program Claims

Job Summary

Reporting to the Chief Claims Officer and serving on the Group Claims Leadership Team, the Vice President, Program Claims is responsible for executing and delivering on the established goals and objectives of the Group and specifically for implementing the strategic vision for managing claims handled by third-party administrators for our Specialty Admitted Program Segment.  The VP, Program Claims has overall responsibility for the engagement and claim results produced by our approximately (thirty) 30 third-party administrator partners and the teams of program auditors that report to this position.  Duties include the leadership of TPA Oversight Auditors in the management and oversight of third-party administrators including TPA selection, audit and review of compliance with contractual, legal obligations and other internal controls, assistance with TPA contract drafting and placement, preparation of special handling instructions, TPA fraud reporting, training and compliance, preparation of workflows to ensure accurate information exchange with TPA partners, and preparation and analysis of reports reflective of TPAs meeting key performance indicators, benchmarks and other obligations. 

Duties and Responsibilities

• Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service.
• Develop and implement long-term strategies to drive continuous improvement, streamline processes, and enhance overall productivity and quality standards throughout the department, while establishing and maintaining Claims Best Practices
• Direct the day-to-day operations of the Program Claim Team, including claim intake, investigation, evaluation, and settlement processes
• Responsible for the results of TPAs engaged by the company.  Communicate the results effectively with internal partners and senior management.
• Determine financial authority framework for TPA’s, TPA Oversight Managers and provide financial oversight and authority on claims matters.
• Works closely with underwriting team and reinsurance partners in the vetting and onboarding of new Programs, MGA’s and TPA’s.
• Advise and assist the SVP, Chief Claims Officer on strategic initiatives and operational priorities
• Prepare and maintain operational expense and salary budget for the Program Claim Team
• Oversee management of staff to include ensuring correct staffing levels and Claims Best Practices are met, development and communication of department goals, setting of individual performance goals, talent and performance management and training
• Evaluate efficiencies of the team and departmental processes to identify gaps, and areas of improvement
• Oversight of internal and external portfolios and claim reporting.
• Review, edit, and approve coverage declination letters, Reserve Reports and Large Loss Reports
• Ensure accurate payment of claims and estimation of claim exposures.
• Communicate with and report to Underwriting, Risk Management, Legal, Finance, and the Ceded Re department on claims-related matters
• Communicate with the Segment President & CEO and Underwriting leaders on significant claim activities and developments affecting company business
• Identify ongoing educational and training needs within the claims department and assist in coordinating relevant training initiatives
• Ensure compliance with state regulations, industry standards, and best practices in claims handling, maintaining a high level of professionalism and integrity

Knowledge, Skills and Abilities

• Expert knowledge of P&C insurance industry, reinsurance, fronting market, MGA’s, regulatory environment, and subject matter expertise in workers’ compensation
• Expert knowledge of the theories, principles, practices and procedures of claim and litigation management within an insurance organization
• Advanced/Expert knowledge and skills in a variety of claims specialty areas
• Expert knowledge in litigation process and management
• Demonstrated leadership and team building skills
• Advanced proficiency in MS Office (Word, Excel, Outlook)
• Demonstrated experience in the ability to attract, lead, motivate, influence, and mentor staff
• Excellent written, verbal, and presentation skills
• Ability to identify and make process and procedure improvement recommendations, including documentation and communication of changes through appropriate change management processes
• Ability to effectively mitigate and drive change
• Strong analytical skills
• Strong negotiation skills
• Ability to build relationships and influence decisions
• Active listening skills
• Excellent organizational skills
• High level of initiative and motivation
• Proven ability to provide exceptional customer service
• High degree of business acumen
• Able to identify, analyze and develop solutions for complex claim issues

Experience and Education

• Bachelor’s Degree required
• Advanced degree or law degree preferred
• Minimum of fifteen years P&C claims handling experience including working with complex coverage issues, workers compensation experience, handling liability and coverage issues, multi-jurisdictional claims, and negotiating settlements with claimants and attorneys required
• Minimum of ten years of people management experience (supervision, mentor, lead) required

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