Job Summary: To help achieve my client's company vision of being the highest performing specialist insurer. This will be done through the proactive management of claims, at the individual and portfolio level, to optimize spend and achieve high levels of satisfaction for the insured and broker through high quality claim management, resolution and excellent client service.
Individual Claims Leadership
- Proactively manage individual claims from notification to closure, investing the necessary level of involvement required for each claim depending on, inter alia, the nature, category, maturity, type and quantum of the claim.
- Follow at all times Claims Reserving Philosophy and Claims Standards.
- Develop, iterate, document and execute claims strategies taking into account uncertainties, key decisions, potential outcomes and estimated associated costs.
- Understand and implement "Treating Customers Fairly" policy.
Claims Portfolio Management
Manage claims portfolio(s) to optimize performance including:
- Regularly review individual claims within the portfolio and keep reserves and records up to date as required by claims controls and standards.
- Identify issues and trends in the portfolio and take appropriate and/or corrective action.
- Keep Reinsurance and Finance advised of any material claims as set out in your claims authority and claims protocols and procedures and work with Reinsurance to effect recoveries.
Working with Underwriters
- Develop an understanding of marketing and underwriting strategies for your business area and contribute to business development and renewal opportunities by attending client meetings to explain the claims philosophy and approach to claims handling, and discussing any claims issues.
- Provide input to underwriters on review of potential or existing insured's claims experience.
- Feedback claims trends and developments and their potential impact on the book.
- Suggest wordings improvements.
Authority & Minimum Standards Observance
- Operate within your approved claims authority at all times.
- Have thorough knowledge of industry regulations and minimum standards to ensure compliance with the regulations and claims and underwriting control standards and protocols.
Third party Management
- Follow procedures for the selection and retention of 3rd party professionals and manage these relationships to the benefit of the company.
- Where required conduct file reviews or audits and resolve any issues identified.
- Pro-actively and regularly provide feedback on the claim actions undertaken by the TPA, propose strategies for future claims handling, review case reserve adequacy, and ensure the TPA remains focused on claim finalization.
- Periodically review TPA performance data consistency with claims service requirements, claims best practices, and financial goals.
Broker and Insured Relations
- Work proactively to develop and manage strong relations with key brokers and insureds.
- Promote the company brand of excellence and professionalism in client service.
Education and Qualifications
- JD preferred
Skills and Abilities
- Analytical skills: Problem solving (broad-based, analytical, conceptual, creativity), Analysis of financial statements, Financial assessments of claims, Data analysis, Decision-making
- Work management skills: Time and workload management, Self-starter, Planning, Achievement orientation, Productivity focus
- Interpersonal skills: Ability to influence others, Client and broker management skills, Purposeful communication, Flexibility, Active listening
Knowledge and Experience
- Past claims experience establishing liability and / or settlement resolutions
- Functional knowledge & understanding: Claims management process, US/RoW Insurance market (general & focus group), US legal and regulatory environment, Alternative resolution approaches