[Hiring] Vice President, Claims @Group 1001

Role Description

The Vice President of Claims will be primarily responsible for the technical, operational, and administrative claim functions, including reserving practices.

• Lead all aspects of claims management for the organization.
• Responsible for technical, operational and administrative claims functions including reserving practices.
• Select and manage performance of Third-Party Administrators, Managed Care and other claims vendors.
• Oversee transitions/implementations of new claims TPAs.
• Manage key department-wide function(s) such as training, talent development, and change management.
• Lead and direct the claims management process, driving execution of best practices and related initiatives to reduce the total costs of claims, while providing exceptional member service.
• Provide the highest levels of technical direction to the adjuster team on significant claims and complex coverage issues.
• Establish Key Performance Indicators (KPIs) for all areas of claims operations, design reports to capture same, review and analyze monthly data and direct corrective actions where required.
• Manage and report on the quality assurance processes to evaluate the TPAs and defense panels’ adherence to claims handling standards.
• Ensure case reserves are consistent with our guidelines and philosophy. Monitor actual reserves to confirm accuracy.
• Prepare reports for Executive Leadership Team and lead review and discussion of same.
• Directly oversee the TPAs’ activities on workers’ compensation, commercial auto, and general liability claims.
• Establish and extend authority levels on all referred claims.
• Select, train and manage staff where necessary.
• Provide technical support to internal business partners, including underwriting, finance, and actuarial.
• Oversee the performance of claim audits quarterly.
• Track and analyze ALAE to ensure effectiveness and efficiency.
• Ensure claims are adjusted in accordance with applicable State laws and regulations.
• Oversee and analyze cost containment mechanisms (early reporting, directing injured employee to preferred provider, utilizing preferred pharmacy, etc.).
• Pursue prompt and accurate closure of claims.
• Manage claims reporting responsibilities for state agencies and reinsurers.
• Represent the company on claims-related matters with external business partners.

Qualifications

• 15 or more years of work experience in an insurance company claims department or TPA.
• Advanced skills in coverage and insurance policy analysis, litigation management principles, investigative and negotiation techniques.
• Strong organizational skills and detail oriented.
• Ability to work independently and handle multiple tasks simultaneously.
• Strong working knowledge of Workers’ Compensation, Auto Liability, General Liability, Professional Liability and Employer Liability claims.
• Excellent verbal and written communication skills.
• Excellent customer service and collaboration skills.
• Extensive knowledge of P&C regulations and applicable law.
• Extensive knowledge of insurance contracts and adjusting techniques.
• Familiarity with medical terminology, legal procedures, and claim evaluation.
• Demonstrated leadership, coaching, influencing, and teamwork skills.
• Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint.
• Previous supervisory experience required.
• Strong vendor management skills.

Compensation

Our compensation reflects the cost of labor across several U.S. geographic markets. The base pay for this position ranges from $180,000/year in our lowest geographic market up to $225,000/year in our highest geographic market. Pay is based on a number of factors including market location and may vary depending on job-related knowledge, skills, and experience.

Benefits

• Employees who meet benefit eligibility guidelines and work 30 hours or more weekly, have the ability to enroll in Group 1001’s benefits package.
• Employees (and their families) are eligible to participate in the Company’s comprehensive health, dental, and vision insurance plan options.
• Employees are also eligible for Basic and Supplemental Life Insurance, Short and Long-Term Disability.
• All employees (regardless of hours worked) have immediate access to the Company’s Employee Assistance Program and wellness programs—no enrollment is required.
• Employees may also participate in the Company’s 401K plan, with matching contributions by the Company.