Senior Director of Claims

Please make an application promptly if you are a good match for this role due to high levels of interest.

Location : Boston

Skills

• Process Design / Management and Reporting
• Strong Customer Service skills and ability to influence others
• Ability to engage cross functionally in support of strategic business goals
• Effective communication with multiple levels of the organization including executive leadership as well as with vendors / claimants as needed.
• Sound decision making skills having practical sense of escalation needs
• Effective leadership skills with ability to motivate team members / vendors / peers
• Detail oriented with solid ability to apply analytics to decision making and KPI development

Knowledge and Experience

• Experience designing and leading claims management programs
• Experience in partnering with Legal, TPA and Insurers for effective claims litigation management
• Financial acumen in liaising on actuarial studies and accrual management
• Demonstrated knowledge of best practices in claims management
• Experience developing educational materials to communicate / educate program stakeholders
• Knowledge of RMIS systems
• Proficiency in Microsoft Office Programs - Word, PowerPoint, Excel
• 7+ years of Insurance and Claim Management

Education

• Bachelor’s Degree
• Professional Certifications / Designations such as CIC, ARM, CRMP, CPCU preferred.

Key Accountability

Claims Process Management

• Work with location and TPA to ensure effective processes of preservation / collection of all pertinent documentation including videos, recordings, etc. for investigations
• Partner with TPA to evaluate and develop strategies for prompt resolution
• Collaborate with In-House Legal with respect to litigated claims and settlement activity
• Seek and maintain best practice claim management processes (e.g., prompt claimant contact, expression of empathy; resolution strategy development; prompt resolution)
• Interact routinely with internal and external customers
• Oversee the development of monthly claims reports in partnership with TPA and or financial analyst. Present to various audiences including CEO.
• Meet monthly with TPA for program status, needs, trends, action plan updates
• Collaborate extensively with stakeholders related to safety, risk mitigation, and claim reduction
• Review claim reports and determine defense / development and provide feedback to TPA to develop strategy for resolution taking accident / event severity; known facts and venue
• Review reserve needs with TPA for appropriateness, presenting changes to the Reserve Committee with justification ensuring approvals in line with delegation of authority.
• Identify cases to litigate and engage In-House Litigation Attorney on strategy
• Attend settlement conferences and mediation when necessary
• Conduct routine claim reviews with business leaders, adjusters, safety, finance, and leadership
• Conduct post review of all significant resolutions to identify strengths and areas for improvement in the claim management process

Insurance Program Management

• Lead insurance renewal strategy and analysis discussions
• Oversee development of renewal submissions

Innovation Projects

• Work with external partners, i.e., panel counsel; insurance consultant; vendors as well as internal partners to identify and evaluate process flows, tools etc. to enhance program
• Utilize Insurance Broker resources to provide 3rd party audits with development of action plans for improvement based on audit results
• Utilize TPA audit findings to develop process improvement strategies and action plans
• Support business development team in modeling insurance and claims projections for bidding opportunities and participate in RFP efforts

Additional Statements

Drug and alcohol screening : Employment contingent upon passing pre-employment drug and alcohol screen. Also, contingent upon receiving a favorable background check.

Must pass a physical examination.

• Safety commitment : Safety is a way of life at Keolis. By placing safety first, we ensure the wellbeing of our employees, customers, and communities.
• Environmental commitment : Keolis is committed to protecting the environment by minimizing the impact of operations to our people and the communities in which we operate.
• EEO statement : Our policy is to afford Equal Employment Opportunity to qualified individuals regardless of their race, color, sex, religion, age, creed, marital status, national origin, ancestry, physical or mental disability, sexual orientation, or gender identification.

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