PRIMARY PURPOSE: To act as a department subject matter expert by providing guidance to the complex claims team to ensure consistency resolving matters optimally while creating a culture of continual quality improvement destined to elevate the overall claim handling to benefit our stakeholders; to ensure the consistency in the developed targeted solutions, and technical guidance and oversight provided to claims team.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Proactively and strategically manages a complex claim inventory by assessing highly complex claims issues, utilizing jurisdictional expertise, providing oversight, and helping direct the handling to achieve the best possible resolution.
- Assists the claims team as their subject matter expert to assist in addition to lines of business and key jurisdictions on complex claim issues.
- Uses knowledge of all aspects of claims handling in evaluating exposure; recommends and directs action plans for issue or case resolution.
- Articulates and documents clear and concise file notes to allow stakeholders to understand the issues and path to resolution.
- Facilitates roundtables with groups/teams; engages appropriate internal and external resources as needed.
- Provides technical leadership on and maintains co-ownership of complex claim issues; creates a culture of continual quality improvement through further influence.
- Assists in the evaluation and development of policies and procedures.
- Mentors and provides guidance to the complex claim consultants and complex claim analysts.
- Leads calibration exercises ensuring consistency through the exchange of ideas and strategies.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.
Education & Licensing
Bachelor's degree from an accredited college or university preferred. Industry designation(s) preferred. Licenses as required for specific jurisdictions.
Ten (10) years of casualty claims experience or equivalent combination of education and experience required to include five (5) to seven (7) years of experience handling complex claims and experience in negotiation, mediation, arbitration or ADR skills on higher value complex claims. Supervisory experience preferred. Specific jurisdictional expertise required.
Skills & Knowledge
- Ability to obtain and maintain appropriate licensing
- Leadership/management/motivational skills
- Analytical and interpretive skills
- Ability to manage claims across multiple jurisdictions
- Excellent oral and written communication skills
- PC literate, including Microsoft Office products
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies.