AVP, Programs Claims, North American Claims Group

Job Title:| AVP, Programs Claims, North American Claims Group
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Department:| Claims
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Job Summary:| Work with the members of the Programs Claims Team to drive strategic initiatives in the handling of various claims which are being directly handled by the Company’s third-party administrators (“TPAs”). Engage in collaborative projects in support of other areas of the company, including underwriting, finance and accounting, actuarial, operations and technology.
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Job Duties:| · Develop project plans, manage milestones, and monitor key metrics to report progress to senior management.· Lead end-to-end claims projects, from planning to execution, implementation, and post-go-live support.· Identify and eliminate obstructions to progress through better procedures, training, and policy enforcement. · Prepare and maintain regular reports on plan implementation, key metrics, and plan execution.· Work with members of the Programs Claims Team to help execute and drive forward strategic initiatives.· Help mentor members of the Programs Claims Team. · Approve reserves, payments and other actions consistent with authority.· Conduct periodic claim file reviews and monitor claim litigation.· Provide back-up for claim staff.· Interact with outside TPA supervisors and program administrators regarding claims oversight, trends, etc. · Conduct TPA audits along with analysts on the team. · Interact with underwriters concerning claims trends and strategic initiatives.· Interact with Legal & Compliance as necessary regarding enhancements/modifications to policy forms and endorsements as well as the TPA service agreements. · Meet with actuaries and finance as required. · Interact with Claim Operations as necessary regarding enhancements to claims systems and other operational issues.· Assist with claims related queries in internal and external audits. · Work with reinsurers as needed.