MEC’s Claims Department leverages a multi-disciplinary claims team composed of claims analysts, medical management consultants, and legal professionals to optimize care and recovery of injured workers. The Director of Claims will oversee Regional Claims Managers and provide strategic technical direction. This role emphasizes leveraging technology to optimize reserving, cost containment, and settlement processes. The Director of Claims will ensure compliance with corporate policies, continuously improve claims procedures, and report directly to the Vice President of Claims.
Key functions include but are not limited to:
Team Leadership & Management
- Lead, mentor, and supervise Regional Claims Managers and their teams of Analysts and Examiners.
- Maintain appropriate staffing levels according to workload demands.
- Assist in identifying and selecting staff and oversee their ongoing training and development.
Strategic Improvement & Technology Integration
- Work with senior leadership to develop and refine claims handling models, processes, and workflows to maximize effectiveness and efficiency.
- Partner with Claims and IT business leads to identify and implement automation and data management enhancements.
- Evaluate and enhance standard operating procedures to drive innovation in claims handling and customer service.
Quality Assurance & Compliance
- Manage corporate quality assurance programs and align claims operations with strategic objectives.
- Conduct regular file reviews to ensure compliance with company standards and regulatory requirements.
- Stay updated on judicial legislative changes affecting claims handling and jurisdictional exposures and promptly communicate necessary adjustments.
Financial Oversight
- Address all reserving, payment, and settlement requests within the position’s authority.
- Develop and manage the annual expense budget for areas of direct responsibility, ensuring adherence to financial targets.
- Analyze and report on claims data to evaluate performance relative to established objectives and recommend corrective actions as needed.
Performance Management
- Utilize performance management and review processes to maximize staff effectiveness.
- Identify staff training needs and recommend targeted development solutions.
Claims Support & Resolution
- Oversee the investigation and resolution of assigned claims, ensuring efficient handling of coverage, exposure, subrogation/recovery, and settlement.
- Provide technical claims support to internal business partners.
- Ensure consistency in claims processes use of systems/applications, and customer experience.
- Lead regional claims teams to effectively resolve claims issues.
Collaboration & Communication
- Foster strong business relationships with insureds, brokers, TPAs, and internal stakeholders.
- Collaborate with underwriting, actuarial, and sales teams to align claims strategies with broader business objectives.
- Maintain exceptional oral and written communication skills, tailoring communications to varied audiences.
- Remain calm under pressure, demonstrating excellent organizational skills, integrity, and follow-through.