Description
Job Description:
Senior level claims position oversees a unit of 5-8 people and their respective caseloads. Manage your units claim metrics and ensure they are kept current. Oversee all aspects of file handling on pending claims, including facts of loss, coverage analysis, investigation, negligence/compensability/liability determinations, damage assessment and coordination of medical care as appropriate. Approve and monitor litigation management, settlement negotiations, and appropriate use of vendor tables. Establish and approve reserves as needed. Ability to attend conferences, client meetings, mentor adjusters and assist management as requested. Ensure files assigned to the unit are handled within state statutes, Client Claim Handling Guidelines, and NARS Best Practices. Other miscellaneous duties as assigned, which may include travel.
Essential Duties and Responsibilities:
- Effectively supervise a unit of 5-8 claims people and their respective caseloads in a proactive
- Adhere to all file handling standards, NARS Best Practices, state statutes, and requirements necessary to pass audits performed by regulatory agencies, carriers, and clients. Form well-written emails and LLR's internally and
- Demonstrate a strong commitment to the mission and values of the
- Maintain strict confidentiality of client, company, and personnel information.
- Works closely with Quality Assurance to ensure company objectives are
- Review and respond to claim appeals and grievances, investigate, and respond to
- Adhere to the policy and procedures of
- Lead and manage by example to promote the culture of service and continuous
- Provide leadership to achieve key business
- Assign accountability for desired outcomes and hold adjusters to required
- Communicate clearly and provide adequate
- Track trends by program and unit – know the team’s claims when a client
- Know the Team’s Clients and be able to confidently discuss their
- Effectively manage corrective action processes in accordance with Human Resource
Reserves:
- Responsible for overseeing adequate reserving of claims files and quality and efficient claim handling of files assigned to
- Maintain appropriate diary on pending claims within the unit and ensure same for
Team:
- Handle performance evaluations, attendance reporting and miscellaneous personnel
- Conduct periodic one-on-one meetings to discuss goals/aspirations and SCORE, C3 diary, Skillset analysis to define strengths/ weaknesses & development.
- Conducting audits of adjusters (2 files per month per adjuster).
- Routine analysis of pending and staffing for timely redistribution or requisitions, hiring, training and development.
- Create Individual Development plans and written training plans where
- Coordinate HR functions with HR and the Department Director regarding progressive
- Conduct monthly Unit meetings to cover successes and areas of opportunity for
- Complete employee PE reviews within requested time frame with IDP and training plans included. Follow up with employee if not meeting.
Litigation:
- Coordinates third party claim settlements with carriers, reinsurer, or plan
- Control and direct activities of defense counsel either directly or indirectly through
- Responsible for approval of the assignment of legal defense of
- Responsible for appropriate unit activities as relate to the litigation process, timely reporting of litigated files to management and round table
Customer Service/Contact:
- Responsible for client satisfaction, claim reviews and audit results for the
- Handle all miscellaneous assigned duties and projects as assigned by upper
- Ensure program management, carriers, and/or reinsurer receive appropriate claim notifications and referrals on large or potential large.
- Resolve customer complaints according to Best Practices, monitoring customer satisfaction to drive action plans for
- Follow up with Director on client issues and action plan for results on
Review/Report:
- Conduct regular file reviews/audits for trend detection and correction of negative
Qualification Requirements:
Education / Licensing:
- High School Diploma or equivalent required, 2-year degree or higher preferred.
- Must have 10+ years of overall claims and litigation experience, preferably in the line of business being handled.
- Must have 5+ years of Claims Supervisory experience or similar/related experience in the appropriate field including restaurant/premises, product liability
- Must be eligible for reserve/payment authority level of $100,000+ (where client appropriate).
- Must possess or have the ability to obtain a Florida Adjuster’s license or other required jurisdictional licensing.
Technical Skills:
- Advanced level of interpersonal skills to handle sensitive and confidential situations and
- Requires advanced technical skills and ability to assist claims unit adjusters with litigation direction and settlement negotiations with attorneys and arbitrators on first and third-party
- Advanced ability to work
- Advanced level of organization and time management
- Advanced level is written and verbal communication
- Must be able to analyze claims data and explain and appropriately respond to auditors, clients, and potential clients during in-person
- Advanced knowledge of various computer software applications in word processing spreadsheets, database, and presentation software (Microsoft Office platform).
Abilities:
- Requires some travel, including overnight and weekends as
- Valid driver’s
- Willingness to work flexible
- Requires some lifting of boxes (marketing materials and displays) up to approximately 20
- Ability to persuade and influence
- Ability to develop and deliver
- Ability to create, compose and edit written
- 24/7 accessibility
- Must have Sales or Marketing
- Repeated use of keyboard, mouse, and exposure to computer screens from either a desktop or laptop computer.
- Requires long periods of sitting.