AVP, Claims - Public Entities

About the role

We’re seeking an experienced and dynamic Associate Vice President, Claims to lead and oversee the management of property and casualty (non-professional liability) claims for member municipalities within various public entity insurance pools. This role is pivotal in ensuring best-in-class claims handling, compliance, and operational excellence.

Responsibilities

• Lead and direct the claims management process, driving execution of best practices and related initiatives to reduce the total costs of claim while providing exceptional member service.
• Provide the highest levels of technical direction to the staff liability claim professionals and management team involving significant claims and complex coverage issues.
• Consult as needed with the outside vendors and attorneys on applicable claim issues.
• Manage the quality assurance programs to evaluate TPA’s and defense panels adherence to claims handling standards.
• Ensure case reserves are consistent with operational guidelines and philosophy.
• Select, train, and manage staff.
• Analyze claims results data relative to established objectives. Report on observations and recommend remedial action.
• Establish and extend authority levels on all referred claims.
• Establish and operate various claims reporting committees involving claims staff and executive management.
• Perform best practice reviews of open and closed claims.
• Provide technical support to internal business partners, including underwriting and risk management.
• Facilitate resolution of any provider issues (billing, appointment setting, etc.).
• Ensure that all joint insurance fund claims and coverage rule sets (SIR’s, EPL/POL deductible/coinsurance, managed care fee allocation and payment, etc.) are checked for accuracy.
• Perform claim audits as directed.
• Create and analyze standard claims reporting package: Monthly department performance report – metrics inclusive of Open/Closed, average Incurred, Claim Frequency, Claim Duration, loss ratio (Developed/Expected/Incurred).
• Detail claim analysis on claims valued over $25,000.
• Quarterly client dashboard report – benchmark current frequency & loss ratio against YTD experience.
• Track, analyze and implement action plans to address key performance indicators- i.e. lag time, closing ratios, days to closing, etc.

Requirements

• Education: Bachelor’s degree required. J.D. preferred.
• Chartered Property Casualty Insurance (CPCU); Associate in Claims (AIC), Senior Claim Law Associate (SCLA) designation or similar professional designation preferred.
• Experience: 7+ years claim management experience. 10 or more years of experience in an insurance company claims department, TPA or corporate risk management department. 3+ years managing litigation specialists and/or P&C claim handlers preferred.

Competencies

• Advanced knowledge of New Jersey casualty claims practice, key applicable statutes, regulations, and common laws.
• Thorough knowledge of the application of Title 59 and OPRA to NJ municipalities.
• Strong working knowledge of Auto Liability, General Liability and Property claims.
• Advanced skills in coverage analysis, negligence principles, investigative and negotiation techniques.
• Strong organizational skills and detail oriented.
• Ability to work independently and handle multiple tasks simultaneously.
• Excellent verbal and written communication skills.
• Excellent customer service and collaboration skills.
• Extensive knowledge of insurance contracts and adjusting techniques.
• Familiarity with medical terminology, legal procedures and claim evaluation.
• Demonstrated leadership, coaching, influencing, and teamwork skills.
• Computer literacy, including working knowledge of MS Office Product Suite, i.e. WORD, Excel, PowerPoint.
• Previous supervisory experience required.
• Strong litigation and vendor management skills.