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About the role
Key responsibilities & impact- Oversee all aspects of the Claims function, ensuring operational compliance with state and industry regulations.
- Develop and present to AVP leadership an operational plan that balances workload management, staff development, and process optimization goals.
- Model and maintain a strong culture of accountability and transparency at all levels of the department, taking ownership of decisions, outcomes, successes, and challenges.
- Build and maintain high-performing claims leadership and examiner teams, fostering a culture of development-focused coaching and holding leaders accountable for team performance through quantitative and qualitative measurements.
- Oversee quality review and control processes for all claims activities.
- Ensure appropriate claims governance, including authority levels, escalation protocols, and proactive identification and mitigation of risk issues or events to minimize impact and recurrence.
- Provide technical leadership on complex claims, including contestable and accelerated benefit claims, ensuring this high-risk function is managed effectively and accurately.
- Ensure unresponsive claims are processed timely under unclaimed property/escheatment guidelines, satisfying regulatory requirements.
- Partner with claims leadership, legal, and other stakeholders to ensure timely response to appeals of adverse claim decision and consumer and insurance department complaints.
- Build and maintain effective relationships with internal stakeholders and external partners, including TPA oversight, for claims reporting, payment processing, and service delivery.
- Proactively identify and lead initiatives across the Claims organization, including workload strategies, process improvements, and technology advancements that drive efficiency and effectiveness.
- Ensure proper development and maintenance of standard process documentation and job aids, cultivating a culture of continuous improvement where materials are updated as changes are implemented.
- Prepare claims operations reports that highlight trends, performance against metrics, and key opportunities, providing data-driven insights to support leadership decision-making.
- Report regularly to the AVP on claims team performance, escalated issues, and operational risks.
- Monitor Claims expenses to ensure good stewardship of company resources.
Requirements
What you’ll need- Bachelor's Degree
- 8+ years life, annuity, and/or disability claims experience, including demonstrated expertise in contestable and accelerated benefit claims
- 3+ years of experience leading teams in a claims environment, with preference for experience managing other leaders
- Demonstrated experience managing relationships with external partners or TPAs, ensuring accountability and service delivery standards are met
- LOMA designations and/or formal process improvement training (e.g., Six Sigma, Lean) strongly preferred
Benefits
Comp & perks- Employee-centric flexible environment
- Ability for in-office, hybrid and remote work arrangements
- Reasonable accommodations for applicants and candidates with disabilities
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims managementprocess optimizationquality reviewrisk managementdata analysisperformance metricsclaims governanceunclaimed propertyescheatment guidelinestechnical leadership
Soft Skills
accountabilitytransparencycoachingrelationship managementteam leadershipcommunicationproblem-solvinginitiativecontinuous improvementstakeholder engagement
Certifications
Bachelor's DegreeLOMA designationsSix SigmaLean
