Overview:
Our insurance client is seeking an experienced Workers’ Compensation Claims Director to lead claims operations and provide strategic direction across the organization’s Workers’ Compensation portfolio. This individual will oversee claims performance, ensure quality and regulatory compliance, develop claims strategies, and lead a team of claims professionals in delivering exceptional outcomes for policyholders and business partners.
The ideal candidate will bring a strong technical Workers’ Compensation background, proven leadership experience, and a track record of improving claims outcomes, controlling loss costs, and developing high-performing claims teams.
Compensation & Benefits:
- $120,000 - $140,000/year based on experience
- Comprehensive benefits package including medical, dental, vision, and 401(k)
- Generous PTO and holiday schedule
- Hybrid work flexibility
Qualifications/Requirements
- Bachelor’s degree in Insurance, Risk Management, Business, or a related field preferred.
- 8+ years of Workers’ Compensation claims experience, with progressively increasing responsibility.
- 3+ years of claims management or leadership experience required.
- Strong technical knowledge of Workers’ Compensation claims, including indemnity, medical, litigation, reserving, settlement, and return-to-work strategies.
- Demonstrated experience managing complex and high-exposure Workers’ Compensation claims.
- Experience managing claims teams and developing high-performing claims professionals.
- Strong understanding of Workers’ Compensation regulations and compliance requirements across multiple jurisdictions.
- Proven ability to analyze claims data, identify trends, and develop strategies to improve loss results.
Responsibilities
- Provide strategic leadership and oversight of the Workers’ Compensation Claims Department, including indemnity and medical claims.
- Direct day-to-day claims operations and ensure claims are handled in accordance with company guidelines, regulatory requirements, and industry best practices.
- Lead, coach, mentor, and develop claims professionals while establishing performance expectations and measurable goals.
- Oversee claim investigation, compensability determinations, reserving, litigation management, settlement negotiations, and claim resolution.
- Monitor claims performance, loss trends, reserve adequacy, and key performance indicators to identify opportunities for improvement.
- Develop and implement claims strategies designed to improve outcomes, reduce claim costs, and enhance operational efficiency.
- Provide technical expertise and guidance on complex Workers’ Compensation claims, including catastrophic and litigated exposures.
- Partner closely with underwriting, actuarial, risk management, legal, finance, and other internal stakeholders.
- Oversee relationships with TPAs, defense counsel, medical providers, vendors, and other external partners.
- Ensure compliance with applicable Workers’ Compensation laws, regulations, company policies, and service standards.
- Review claims trends and analytics to identify emerging exposures and recommend appropriate action.
- Establish and maintain effective claims procedures, controls, and quality assurance standards.
- Prepare and present claims performance updates, trends, financial results, and strategic recommendations to senior leadership.
- Support budgeting, forecasting, and financial management for the Claims function.
- Stay current on Workers’ Compensation legislation, regulatory developments, litigation trends, and industry best practices.
- Drive continuous improvement initiatives and identify opportunities to enhance the customer and policyholder experience.
- Perform other duties and special projects as assigned.
Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.
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