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OH - Regional Claims Manager - AVP

 
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OH - Regional Claims Manager - AVP
Post Date  5/22/2013
City  Westerville
State  OH
Work Location  Westerville, OH
Department  Claims, Construction Litigation Unit
Reports To  Vice President of Claims - Construction Litigation
Summary  

To effectively manage, plan, organize, control and direct all functions of the Claims Construction Accident Unit. This includes budget, staffing, expense control, training, quality control and service to both external and internal customers. Managers are responsible for the maintenance of all Corporate standards, guidelines and objectives within their business units at all times.

Essential Functions  

 

 

 

1.    Coordinate efforts among the staff and other parties to achieve timely, equitable disposition of claims handled in their region. In cases where files exceed the claims manager’s authority, they coordinate reporting to the next level of authority.

2.    Review, monitor and provide technical expertise to the staff to assure proper adherence to the company guidelines and protocols.

3.    Ensure in-depth investigation of actual claims through either direct or indirect contact with policyholders, claimants, other carriers, physicians, contractors, attorneys, etc.,

4.    Control and direct activities of defense counsel either directly or indirectly through staff.

5.    Encourage and participate in the advanced professional training of their professional staff.

6.    Ensure that all applicable claims within their departments are reported accurately and timely to reinsurance as required by procedure.

7.    Monitor all personnel and staffing functions within their region in accordance with Human Resource policies and salary administration guidelines.

8.    Resolve disputes with customers, TPAs and claim offices.

9.    Handle, with approval of Corporate Claims and the division managers, all media and agency complaints. They promptly notify Home Office of all matters of a serious nature. They also ensure prompt response to all Dept. of Insurance complaints and maintain records of every occurrence and the corrective action taken.

10.  Ensure that all fraudulent claims are reported in a prompt fashion to the appropriate regulatory agencies as well as to Corporate Claims. It is the Claims Manager’s responsibility to ensure compliance with all Special Investigation Units/anti-fraud statutory requirements set by the State.

11.  Prepare or assist in the preparation of annual department budgets, and revise budgets as necessary. Upon approval, the claims manager routinely monitors expenditures and manages his / her department responsibly in accordance with the higher needs of the organization.

12.  Collaborate with other departments in the management of programs.

13.  Closely monitor statutory and case law changes in their jurisdictions.

14.  Communicate strategic vision and strategic direction. Align the daily operations with strategic direction and define goals and strive to focus their staff upon these goals.

15.  Understand and facilitate the Corporate marketing strategies and objectives

16.  Focus upon building a supportive, team-oriented environment for the staff through embodying a sense of empowerment, demonstrating positive thinking and establishing common goals and interdependence with the employees.

17.  Control administrative costs through effective budgeting, appropriate staffing, and close monitoring of ongoing expense allocations.

18.  Ensure the selection of qualified candidates to fill vacancies and support diversity efforts.

19.  Establish and enforce performance standards – setting plans for staff performance improvement and development.

20.  May participate upon request in emergency programs (i.e., Catastrophe team).

21.  Increase knowledge of functional area through internal and external educational programs.

22.  Set reserves on files and distributed reserve and settlement authority to claims staff within Corporate guidelines.

23.  Effectively manage corrective action processes in accordance with Human Resources guidelines and expectations.

24.  Develop and implement a succession plan for self.

25.  Monitor benchmarks and have working knowledge of Expense and Payment controls, Large Losses, Staffing and Performance Management.

26.  Must adhere to and enforce the company code of ethics.

27.  Performs additional related duties as assigned.

 

Requirements  

 

 

 

 

1.    College degree or equivalent experience.

2.    Minimum of three (3) to four (4) years supervisory experience.

3.    Minimum of eight (8) to ten (10) years insurance claims experience, including four (4) to five (5) years in a major line of business or equivalent education with functional experience (i.e., Juris Doctorate or Certified Public Accountant).

4.    Superior technical knowledge of federal, state and local statutes regarding claims activity in the functional are of responsibility.

5.    Ability to analyze complex coverage submissions and provide assistance and apply case law in determinations.

6.    Must be a professional who demonstrates thorough knowledge of functional area of responsibility

7.    Ability to prioritize, organize and plan work for self and others.

8.    Proven leadership abilities

9.    Superior communication (written, oral and presentation) and negotiation skills are necessary.

10.  Superior problem-solving ability.

11.  Ensure assigned files are handled in good faith as defined by statute, case-law and Corporate standards.

12. Prior experience in budget planning and compliance management.

13.  Completed coursework in Chartered Property Casualty Underwriter (CPCU), Associate in Claims (AIC), Insurance Institute of America (IIA), Law for the Claims person, and/or other outside related courses.

14.  Possess a valid driver’s license and State adjusting license(s) as applicable.

15.  Ability to travel as required.

16.  Computer proficient with Microsoft Office programs.

 

 

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