Claims Director
Employer not yet confirmed · Alpharetta, Georgia, United States
Claim Director will handle a senior examiner caseload that includes severity exposures with complex coverage, compensability, litigation, or account management issues.
Claim Director will be expected to
- Have advanced diary management, file documentation, action planning, reserve and exposure analysis skills
Demonstrate ability to use internal and external resources to make appropriate, timely decisions independently and within authority
- Conduct or work with SIU to direct high level investigations
- Collaborate with medical resources to manage unusual injuries and treatment needs
- Address compliance issues and exposures
- Calculate and present significant reserves and settlements to internal & external customers
- Use effective settlement strategies that leverage MSA, structure and subro issues
- Use technical expertise and business acumen to handle account management issues
- Develop capacity to work with the WC management team on projects like new hire on-boarding, compliance training and workflows, best practice audit follow-up
- Mentor junior staff and help identify their training needs
- Exceptional organizational, prioritization and time management skills
- Open communication style that fosters continuous learning and team collaboration
- Advanced team work, collaboration and account management skills
- Outstanding written, oral and presentation skills that are effective with a wide variety of internal and external customers.
- Strong business acumen and understanding of the fundamental components of claims, underwriting, agency relationships, industry strategies and trends.
- High level of accuracy with claim financials: benefits issuance, bill payment, coding, reserves and inventory management and ability to articulate the impact of claims transactions on internal and external customer’s interests.
- Exceptional negotiation skills and resources with demonstrated ability to coach others in use of these techniques.
- Extensive knowledge of insurance contracts, investigation techniques, legal requirements, state compliance and insurance regulations.
- Travel: Yes, 10% of the time for an occasional in person claim review.
- Should have high degree of specialized and technical competence in the handling of claims with emphasis on hands-on file management.
- Minimum of 5 years of work comp claims handling experience.
- College degree or equivalent business experience.
- Ability to work independently and assimilate learning materials on many different subjects from various sources.
- Excellent interpersonal communications, computer and negotiation skills.
- Ability to deal with customers in a professional manner.