The Vice President of Claims has overall executive management responsibility for the claims function at American Mining. The VP of Claims is responsible for the overall direction of claims management and practices of the company. This includes oversight for developing, implementing, and managing policies and procedures to enhance the processing, investigation and settlement of workers compensation claims.
Responsible for the quality of claims management: service delivery to our clients, reserve accuracy, claim resolution, litigation management, network penetration, jurisdictional compliance, and compliance to internal standards.
Provides direction and technical assistance on the most complex claim files.
Develops claims strategic plan and communicates department objectives.
Establish the organizational structure, environment, and accountability of the claims operations in order to deliver services to the business.
Develop and manage relationships with outside vendors, consultants, contractors, and other Company companies in line with company policies and guidelines.
Developing and maintaining claim/ legal resources to include attorneys, adjusters and expert witnesses.
Coordinate creation/maintenance of physician panels.
Keen interest in data analytics and ensures the claims department has effective analytical tools and resources to enable decision making and gain department efficiencies.
Acquires the best claims talent; ensures effective training and development plans are in place for associates to excel in their roles and retain talent
Monitors critical claim data and provide reports to company leadership team on items of importance.
Conducts effective department meetings to inform, solve problems, coach, and improve claim operations.
Interacts on a regular basis with underwriting, actuarial, risk management, marketing, finance, and information technology.
Handles complaints and inquiries from agents, consumers and various regulatory agencies referring those requiring involvement of others.
Develops employees through coaching, training, providing ongoing and constructive feedback
Retains staff by managing responsibly and creating a positive work environment.
Keeps abreast of industry developments, particularly those which impact area of responsibility.
Minimum 10 years management experience in the Insurance Industry, with heavy emphasis in workers compensation
College degree; MBA, CPCU preferred
Possess a working knowledge of all functional aspects of insurance company and third party operations (i.e., claims, underwriting, marketing, risk management)
Comprehensive knowledge of insurance and legal systems.
Demonstrated technology, analytical and creative problem solving skills.
Professional drive to exceed expectations; passion for excellence
Exhibit highly defined leadership and interpersonal skills
Ability to establish, develop, and maintain professional relationships
Limited overnight travel (approximately 20%) to address serious injuries, attend meetings and conferences.
Exhibits professional behavior at all times while representing or being identified as an associate of Company.
Demonstrates tact and discretion in all communications and provide a positive contribution to the morale of the department.
Establishes and maintains effective working relationships with staff, clients, providers, and other departments.
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