Responsible for the effective overall management of the claim files and personnel assigned to a set of functions or a specific line of business, e.g. Subrogation, SIU, Customer Service and Training. Coordinate, consult and manage resources to ensure the effective execution of objectives for the assigned areas of responsibility or line of business and related functions. Direct and monitor services and claims in the assigned functions and/or line of business to ensure the timely and fair investigation, evaluation and disposition of all claims. Directly manage and oversee the files, projects and programs assigned. Employee must possess demonstrated expertise in handling significant losses of high complexity and severity with sophisticated business and legal nuances. Employee should be highly skilled in all coverage’s written with an emphasis on the most difficult losses and exposures, and be capable of seeing our most difficult adjustments through final resolution using a wide variety of settlement techniques including litigation. Claim outcomes must be consistent with policy terms and conditions, damages and legal requirements. Directly manage and oversee the claim supervisors, service and adjusting staff to assure that they adhere to and comply with all claim file handling guidelines, service expectations and all other job expectations, regulations and requirements.
DUTIES & RESPONSIBILITIES
- Direct and monitor areas of accountability within the assigned authority to produce claim outcomes consistent with policy language, damages and legal requirements.
- Provide input into the preparation and execution of the annual business plan and budget.
- Recruit, select, develop, motivate, train and retain a competent staff.
- Directly manage a specialized group of employees functioning in technical roles in support of to the entire department, e.g. subrogation, salvage, Special Investigations Unit (SIU), litigated claims.
- Monitor and review the claim workload and task counts, and a cross-section of claim files to ensure that productivity levels are met, and that defined quality standards are achieved.
- Perform line of business quality assurance reviews, targeted reviews and reserve reconciliations.
- Review system-generated reports and investigate trends and/or irregularities. Draft explanations and potential responses to findings.
- Recommend and participate in modifications and enhancements to the claims processing systems and systems reports to provide timely and insightful claims data.
- Review referred losses to ensure that claim supervisors are providing specific and appropriate direction to the adjusting staff and service providers.
- Monitor loss adjustment expense and take steps to mitigate or avoid expenses to assist the department in attaining its loss adjustment expense goals.
- Provide coverage direction and interpretation to the claim supervisors, examiners and representatives on referred files.
- Coordinate referral of coverage disputes and policy issues to General Counsel, Claim Vice President and/or coverage counsel.
- Participate in the drafting and revision of the protocol for various types of internal reporting criteria and referral guidelines to claims management.
- Provide guidance and advice to the claim staff, to ensure the equitable and consistent interpretation and resolution of coverage issues department wide.
- Ensure appropriate supervision and expense control of all files within the assigned areas.
- Provide accurate and timely information to all external and internal customers concerning claim status and other claim inquiries.
- Assure prompt and accurate reporting to reinsurers, E&O carriers, accounting and brokers per protocols.
- Collaborate with peer managers on strategy and projects as necessary.
- Provide service calls for policyholders and training for agencies as needed.
- Attend trials, EUO’s, depositions, appraisals, arbitrations and mediations where deemed beneficial or required by jurisdiction.
- Write, approve and administer timely comprehensive performance reviews of assigned staff. Suggest appropriate salary adjustments based upon actual job performance.
- Evaluate caseloads and task counts, and prepare reports analyzing staffing needs.
- Serve as a technical resource within the Department through mentoring and knowledge sharing.
- Improve processes within the Company to increase the level and quality of service provided to internal and external customers, i.e. workflow processes, systems implementation, imaging etc. May be authorized to take full responsibility for such programs or to lead committees.
- Set file direction on complicated or high-exposure matters and recommend appropriate reserves on claim files within discretionary authority.
- Confer with the Vice President of Claims, claim staff, and other company personnel to plan, coordinate and evaluate goals/activities, investigate and resolve problems, and exchange information.
- Qualify, implement and evaluate programs to ensure Vermont Mutual receives valuable services and quality work product from its key service providers at competitive rates. Complete reports quantifying results.
- Assess, coordinate and deliver technical training for agents, adjusters and clerical personnel.
- Respond to customer, agency and Insurance Department communications; reply to data calls, file regulatory reports, etc..
- This position may be called upon to handle a modest claim pending under unusual circumstances such as conflicts of interest, CAT’s, staffing shortages, employee claims, etc.
- Performs other duties or special projects as required or as assigned.
The Vice President of Claims provides general direct supervision.
This job will moderately supervise all levels of Claim Supervisors, Examiners, Representatives and Service Support personnel.
- Graduate Degree or Bachelor's degree in business, insurance or a related field.
- Twelve or more years of relevant claim supervisory and technical experience with demonstrated achievement and progressive responsibilities.
- In depth knowledge of the technical aspects of Property and/or Casualty claims (including automobile and general liability claims and litigation).
- Comprehensive knowledge of property and casualty insurance claims management processes, systems and regulatory requirements.
- Demonstrated commitment to professional development through the attainment of recognized industry designations related to the job such as AIC, SCLA, CFE, JD, CPCU, RPA, CIC, MBA programs, etc.
- Advanced understanding of the insurance industry and company operations.
- Expert skills in specialized area(s) of concentration: including relevant knowledge of contract and tort law.
- Superior technical, analytical, and negotiation skills.
- Excellent verbal and written communication skills.
- Strong planning, administrative and supervisory skills.
- Proficiency with PC applications including Microsoft Office (Word, Excel & Outlook); Experience with imaging and estimating programs preferred.
- Demonstrated ability to exercise good judgement in dealing with professional and personnel situations.
- Proven ability to work effectively with a wide range of outside firms and organizations.
- Demonstrated leadership ability to deal effectively with company management and staff at all levels.
PHYSICAL DEMANDS/WORKING CONDITIONS
- Predominately sedentary office position with high frequency of keyboarding/computer work required.
- The physical demands are minimal and typical of similar jobs in comparable organizations.
- The work environment is representative and typical of similar jobs in comparable organizations.
- Occasional overnight travel.
- Potentially subject to adverse weather and stressful situations with respect to claim disputes.
How to Apply:
Submit cover letter, salary requirements and resume, in strict confidence.