Director of Claims

A reputable regional insurance carrier is seeking an experienced Director of Claims.

The ideal candidate is a proactive, goal-oriented, and highly organized workers compensation claims professional who has a passion for leadership, learning, and innovation and a commitment to excellence. Primarily responsible for the day-to-day oversight of claim-handling and all related functions. Will be a key operational partner working closely with executive leadership to drive strategic initiatives, manage projects, and ensure that claims are handled appropriately according to applicable legal and industry best practice standards. Plays a pivotal role in delivering excellent results by modeling high performance and motivating staff while building strong relationships across teams throughout the organization.

Responsibilities:

Leadership and Team Management

• Provide day to day operational leadership for the claims team in alignment with department goals and executive guidance.
• Lead and develop a highly performing team through staff development, mentoring, and coaching.
• Foster staff growth and accountability, both individually and collectively.
• Develop staff knowledge and expertise by serving as a resource for claim-related questions and technical guidance.
• Assist departmental planning efforts by working with staff to set annual performance goals and monitor results regularly to ensure targets are met.
• Assure the delivery of superior customer service internally and externally.

Operations and Oversight

• Oversee all claim-handling activities and functions and ensure that all functions are executed in compliance with applicable laws, regulations, industry best practices, and department policies.
• Develop and execute effective strategies for managing claims and claims related functions, processes, and workflows.
• Analyze, report, and present data on trends, costs, and KPIs.
• Administer the internal claim review process and provide reports to staff members and executive leadership.
• Manage the timely, adequate, and appropriate setting of reserves through continuous review and analysis, as well as oversight of reserves within reserve authority levels.
• Review settlement evaluations and provide authority within authority levels.
• Provide proactive communication on case activity, department performance, and operational needs.
• Develop and implement operational policies, procedures, workflows, and advocacy initiatives to reduce complaints, disputes, and litigation.
• Monitor reports of suspected fraud and issues of coverage and compensability that may lead to denial of claim to determine if executive review and/or outside counsel is required.

Compliance and Technical Expertise

• Monitor and ensure departmental compliance with all state workers’ compensation commission rules, as well as NCCI, Medicare, and other federal rules and regulations.
• Maintain up to date knowledge of relevant laws and regulations, stays abreast of legislative activity and industry and market trends.
• Timely communicate all developments to staff.

Cross-Functional Collaboration

• Work with Information Systems to develop, test, and implement claims systems enhancements.
• Participate in leadership meetings to provide insights and updates on claims activities.
• Provide technical support and training to internal teams and external stakeholders.

Knowledge, Skills, and Abilities:

• Advanced/specialized knowledge of workers compensation insurance, laws, and regulations.
• Proven ability in staff leadership, coaching, and development.
• Strong expertise in workers’ compensation claim handling.
• Demonstrated fluency of claims processes, controls, and regulatory standards.
• Familiarity with claims management software and data analysis tools.
• Strategic mindset with ability to drive process improvements and customer satisfaction.
• Elevated level of analytical and critical thinking abilities.
• Excellent verbal and written communication skills, including the ability to effectively communicate with internal and external customers.
• Strong leadership and negotiation skills.
• Excellent computer proficiency (MS Office – Word, Excel and Outlook).
• Must be licensed in all relevant jurisdictions or have the ability to obtain licensure as required.
• Must be organized, detail oriented, able to effectively manage time under pressure and meet deadlines while maintaining a positive attitude and providing exemplary customer service.
• Must have the ability to learn new tasks, remember processes, maintain focus, complete tasks independently, make timely decisions in the context of department workflows, and complete tasks in situations that have a productivity quota and/or are time sensitive.

Training and Experience/Minimum Qualifications:

• Bachelor’s Degree preferred.
• Prior experience in the handling and supervision of workers’ compensation claim required.
• 10+ years related experience, including 5+ years of supervisory experience required.
• AIC, CPCU, or ARM designation preferred.
• Experience with multi-jurisdictional claims programs preferred.

Working Conditions:

• Office environment.
• Sedentary work – must be able to remain in a stationary position 90% of the time.
• Occasional travel required.
• Ability to operate standard office equipment and keyboards, walk short distances, exert negligible amounts of force infrequently to lift, carry, push, pull, or otherwise move objects, and/or drive a vehicle infrequently to deliver or pick up materials.
• Must have close visual acuity to perform activities such as: preparing and analyzing data and figures; transcribing; viewing and computer terminal; extensive reading.
• Ability to safely and successfully perform the essential job functions consistent with all federal, state, and local standards.
• Ability to meet qualitative and/or quantitative productivity standards.
• Ability to maintain regular, punctual attendance.

Job Type: Full-time
Salary: $95,000 – $145,000 per year
Schedule: Monday through Friday

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employer paid Disability insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

“The salary range provided is a good faith estimate representative of all potential geographic locations. The final offer will be determined based on the candidate’s primary work location, experience, and specific skills. Benefits are subject to the terms of the specific plan documents.”