Director, Claims

Duties/Responsibilities

• Lead and inspire a service-focused team.
• Oversee the intake, investigation, evaluation, reserving, and resolution of claims.
• Ensure claims are handled in accordance with policy provisions, company guidelines, regulatory requirements, and industry standards.
• Manage complex, high exposure, litigated, or escalated claims.
• Review and approve significant coverage determinations, settlement authority, and denial recommendations where applicable.
• Develop and implement claims handling strategies, workflows, and best practices.
• Establish department goals, KPIs, and performance standards.
• Oversee quality assurance and audit processes for claims handling activities.
• Identify operational, legal, and financial risks within the claims process and implement corrective actions.
• Assist in the development and implementation of reservation of rights letters, coverage position letters, and claims procedures.
• Monitor claim reserves, loss trends, and financial exposure.
• Assist with budgeting and forecasting related to claims operations.
• Ensure appropriate expense management and vendor performance standards.
• Maintain positive relationships with insureds, brokers, members, partners, and external stakeholders.
• Collaborate cross-functionally with underwriting, operations, finance, and customer service teams.
• Provide claims reporting and operational updates to executive leadership.

Qualifications

• Bachelor’s degree or equivalent experience required.
• 10+ years of relevant claims experience.
• 2+ years leadership within a claims management role.
• Valid adjusters license or ability to obtain such.