This position will manage and provide the highest level of technical direction to the Claims Analyst position within a multi-disciplinary regional claims team setting involving medical and legal claims professionals. The Director will provide guidance regarding workers’ compensation and employer liability issues as they pertain to coverage, loss exposure, and file resolution, including settlement. This position will manage the quality of claim handling via the various quality assurance programs to ensure staff adherence to and compliance with established standards of claim handling performance. The Director of Claims will also provide oversight of claims compliance with corporate policies and procedures and will report directly to the Vice President of Claims.
The responsibilities of the Claims Director include:
-Provide technical claims leadership to the Claims Analysts in the investigation and handling of all referred claims. Ensure claim management and case reserves are consistent with company guidelines and philosophy.
-Communicate the status of all referred claims to appropriate internal and external business partners.
-Provide daily coaching to the regional claims staff on coverage, investigation, evaluation, reserving, and resolution of claim files.
-Manage the execution of the corporate quality assurance programs. Work with the VP of Claims on the implementation of corporate strategic objectives as they pertain to claims operations.
-Conduct scheduled and periodic file reviews to ensure compliance with company standards.
-Address all reserving, payment, and settlement requests within position’s authority.
-Maintain appropriate staffing levels in conjunction with work loads.
-Select, train and manage staff.
-Plan and develop annual expense budget for areas of direct responsibility and manage adherence to budget.
-Utilize performance management and performance review processes effectively, on an ongoing basis, to maximize staff performance.
-Identify training needs of staff and recommend solutions.
-Achieve operational business plan goals ensuring regulatory compliance with legal statutes, policy provisions and company guidelines.
-Assemble and analyze claim results data to evaluate status relative to established objectives. Report on observation and recommend remedial action.
-Maintain technical and regulatory expertise in all assigned jurisdictions. Monitor judicial and legislative entities to promptly identify, analyze and communicate changes impacting jurisdictional exposures and claim handling.
-Develop, communicate, and ensure compliance with corporate policies and procedures.
-Lead regional claims teams focused on resolving claims issues.
-Promptly investigate all assigned claims for coverage, exposure, subrogation/recovery, and resolution.
-Provide technical claims support to internal business partners.

The required knowledge and skills are:
-Bachelors’ degree preferred with 7 or more years of equivalent work experience in an insurance related industry required.
-Advanced skills in coverage analysis, negligence 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 and employer liability claims.
-Excellent verbal and written communication skills.
-Excellent customer service and collaboration skills.
- Extensive knowledge of workers’ compensation regulations and applicable law, preferably in multiple jurisdictions.
-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.
-Chartered Property Casualty Insurance (CPCU); Associate in Claims (AIC), Senior Claim Law Associate (SCLA) designation or similar professional designation preferred.
-Strong litigation and vendor management skills
-Willingness to travel for business purposes; Travel is approximately 10%.