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VP, Claims Leader - Med Risk

Jersey City, NJ, USA | Ace Group

  • Industry:
    Insurance - General
  • Position Type:
  • Functions:
    Regulatory Affairs
    Legal / Compliance
  • Experience:
    10-12 years
    12-15 years
    15-20 years
Job Description:
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Lead a team of Medical Risk claim managers and examiners, through the application of Best Practices and strong supervisory skills.

Drive and develop the technical acumen of the team, which handles a significant number of complex and high severity medical liability matters. 

Management of Early Warning System (EWS) on severity claims for accuracy and timely reporting.

Ensure timely and accurate reserving practices

Provide guidance with respect to technical oversight of claims, including timely coverage reviews and coverage correspondence

Control Legal Spend while ensuring superior claim outcomes

Ensure compliance with Casualty Best Practices to ensure claim handling discipline and superior Quality Review and Audit scores.

Management of Inventory to a 1-1 open to closed ratio

Effective management of vendor quality and service, establish and assist in maintenance of vendor panels

Close collaboration with Medical Risk underwriting and actuary business partners to help improve overall performance of Medical Risk portfolio departments regarding claim activities and trends as well as product development.

Leadership


Provide strong leadership as part of NA Claims leadership team

Build and develop organizational talent

Partner with HR to manage talent and diversity, succession planning and build pipeline opportunities.

Develop and execute strategies to create and maintain a dynamic and positive work environment and culture that enables staff to develop personally and technically.

Conduct goal setting and performance appraisals by established deadlines. Create and execute development plans as appropriate, develop ongoing strategies to obtain strong performances from all team members retain high performers. Hire and retain diverse staff.

Develop and execute strategies to create and maintain a dynamic and positive work environment & culture that enables staff to develop personally and technically

Foster clear and consistent communication for the line of business/tower on a regular and consistent basis

Maintain an inventory of period training across the region and drive additional training opportunities in support of the discipline. Share training inventory and opportunities across region to maximize benefit and staff development.

Foster clear and consistent communication for the line of business on a regular and consistent basis.

Provide strong Leadership on key projects and initiatives that make significant impact on the line of business 

Quality/Technical Management


Drive claim teams/units to deliver better outcomes both in loss and expense

Improve Large Loss Management Communication ‐ Large Loss Report (LLR) accuracy and clarity, presentation of claims to Senior Executives and/orUnderwriting business leaders

Ensure compliance with state and federal regulatory requirements as well as internal operational standards

Demonstrate knowledge of severity files and trends

Service, Marketing and Communication


Lead or participate in underwriting, actuarial, client or broker meetings regularly to promote relationships.

Manage the resolution of claim issues/complaints raised by internal and external business partners.

Effectively manage complex business issues and problems.

Ensure satisfactory ratings in all Operational Audit results.

Ensure team’s compliance with all service expectations and standards including development and implementation of actions plans as necessary to address deficiencies or training opportunities as identified by the audit process.

Manage communication consistently with business partners on claim strategy, trends, loss notification and reserve committees.

Lead efforts to collaborate with UW to promote producer and client relationships

Knowledge and Skills Required:


Strong leadership and management skills, ability to work with cross functional business units to achieve goals

Strong communication skills and the capability of communicating at all levels within the organization.

Experience, expertise and direct knowledge of medical risk claims, including Hospital, Long Term care, and other medical facility claims.

Strong analytical skills and ability to analyze claim trends and report on jurisdictional changes; ability to conduct staffing analyses

Catastrophic Claim management expertise and oversight of complex and high severity medical liability claims.

General industry trends and knowledge of legislative activities with regard to medical liability within the United States.

Marketing skills and customer service skills

REQUIREMENTS:


At least 10-20 years of claim experience. active management of casualty claims either with carrier or in-house claims department, preferably medical risk claims, with 5 plus years experience managing teams of claims professionals.

Significant experience managing claim teams handling medical liability matters.

Juris Doctor preferred, or Masters/Bachelor’s Degree in related field

Superior organizational management skills required for management of average 2000+ open claims

Must possess sound negotiating and communication skills.


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