The Head of Claims oversees the management of all claims services and operations of AFBA & 5Star Life’s Claims department. This position provides strategic direction for the claims practices, which includes responsibility for implementing and managing policies and procedures to enhance and improve the efficiency of the processing, investigation, and settlement of all claims. The Head of Claims will oversee the daily operations to ensure that life insurance claims are processed in the most timely and accurate manner to serve the interests of the beneficiary and the company while following state and legal regulations.
The Head of Claims is responsible for the development, leadership, and direction of an effective response program to manage daily claims, as well as work with team to ensure claims management services are exceeding members’ expectations. The Head of Claims will work with business unit leaders to ensure internal departments are appropriately staffed to successfully support members. This position is also responsible for mentoring, coaching, and developing team members using strategies in alignment with the enterprise’s core values.
Essential Duties and Responsibilities:
- Provide strategic leadership to ensure that the company’s claim quality, guidelines and metrics are successfully met. Escalates high risk exposure claims to senior leadership as appropriate.
- Centralizes the claims processing team and implements organization-wide practices that improve efficiency and results. Possess the ability to manage and integrate remote teams both those within the organization and those with third party administrators.
- Develop, coach, train and mentor team members through coaching and feedback on performance. Audits Claims processes and files to identify training opportunities as appropriate.
- Develop and maintain an in-depth technical knowledge of theories and practices within claims management and insurance industry operations; as well as working knowledge of how the claims function integrates with the finance and accounting functions.
- Maintain current knowledge of: all life and health insurance lines; applicable regulations and court decisions which may impact the claims function; current guidelines in the claims function; and policy changes and modifications. This may require attendance at various seminars and training sessions.
- Demonstrates strong executive presence with the ability to present analyses and recommendations in a clear and compelling manner to both technical and non-technical audiences, including executive management.
- Manage the work of vendors to achieve successful resolution of claims.
- Establish and implement standardized, consistent post-incident guidelines to cultivate a culture of accountability related to claims and risk management.
- Evaluate current practices for processing/administering claims and establishes improvements.
Required Knowledge, Skills, and Abilities:
- Ability to communicate professionally and effectively with all levels of the organization.
- Ability to encourage open expression of ideas and opinions.
- Excellent interpersonal skills.
- Ability to document policies, procedures and standard business practices.
- Demonstrates a sense of urgency and timeliness.
- Ability to lead Claims professionals and manage and improve processes.
- Strong analytical skills, with a high degree of organization and attention to detail.
- Strong time management and multi-tasking skills.
- Proficient in Microsoft Office products.
- Comprehensive experience and knowledge of a Life Claims System (preferably FINEOS Claims System).
Education and Experience:
- Bachelor’s Degree in relevant field required. Advanced Degree preferred.
- 15 years in the insurance industry (preferably focused on life insurance).
- Minimum of 7 years in managerial and leadership role.
- General insurance or risk management experience required.
Job Type: Full-time
- Managerial and Leadership: 7 years (Required)
- Life Insurance Industry: 10 years (Required)