Claims Director

Claim Director will handle a senior examiner caseload that includes severity exposures with complex coverage, compensability, litigation, or account management issues.

Claim Director will be expected to

• Have advanced diary management, file documentation, action planning, reserve and exposure analysis skills

  Demonstrate ability to use internal and external resources to make appropriate, timely decisions independently and within authority

• Conduct or work with SIU to direct high level investigations

• Collaborate with medical resources to manage unusual injuries and treatment needs

• Address compliance issues and exposures

• Calculate and present significant reserves and settlements to internal & external customers

• Use effective settlement strategies that leverage MSA, structure and subro issues

• Use technical expertise and business acumen to handle account management issues

• Develop capacity to work with the WC management team on projects like new hire on-boarding, compliance training and workflows, best practice audit follow-up

• Mentor junior staff and help identify their training needs

• Exceptional organizational, prioritization and time management skills

• Open communication style that fosters continuous learning and team collaboration

• Advanced team work, collaboration and account management skills

• Outstanding written, oral and presentation skills that are effective with a wide variety of internal and external customers.

• Strong business acumen and understanding of the fundamental components of claims, underwriting, agency relationships, industry strategies and trends.

• High level of accuracy with claim financials: benefits issuance, bill payment, coding, reserves and inventory management and ability to articulate the impact of claims transactions on internal and external customer’s interests.

• Exceptional negotiation skills and resources with demonstrated ability to coach others in use of these techniques.

• Extensive knowledge of insurance contracts, investigation techniques, legal requirements, state compliance and insurance regulations.

• Travel: Yes, 10% of the time for an occasional in person claim review.

• Should have high degree of specialized and technical competence in the handling of claims with emphasis on hands-on file management.

• Minimum of 5 years of work comp claims handling experience.

• College degree or equivalent business experience.

• Ability to work independently and assimilate learning materials on many different subjects from various sources.

• Excellent interpersonal communications, computer and negotiation skills.

• Ability to deal with customers in a professional manner.