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This position provides technical oversight and coverage guidance to achieve the appropriate outcome on claims up to approved authority.
Significant emphasis on resolution and process improvement, while maximizing cost effectiveness, supporting business partners to attract and maintain business.
The position holds responsibilities with heavy focus on proactive and effective performance of Third Party Administrators and Program Administrators in addition to supervising an assigned claims team on direct handled program claims.
Develops and maintains effective relationships with colleagues, business partners, customers, agents, regulatory agencies and others to achieve organizational goals and create better outcomes.
The position requires extensive multi-line claim experience.
Reviews and analyzes claim detail above the Third Party Administrator authority, while providing direction on reserving and settlement decisions.
Communicates Large Loss Reporting to internal business partners and reinsurers. Provides support to all functional internal departments.
Highly developed skills in negotiating, mediating and/or arbitrating claims. Also may attend trials as necessary.
Conducts and participates in regular audits, program administrator meetings and file reviews.
Adjust reserves and provide reserve recommendations to ensure reserving activities are consistent with corporate policies.
Other duties as assigned.
Perform various processing, billing and data entry functions as assigned and conduct quality control checks on various products.
- Enter data, per underwriter instructions and applications, into rating systems.
- Issue and email policies/endorsements.
- Perform quality control checks prior to emailing policies to agents.
- Communicate with underwriters and agents to ensure a high level of understanding and accuracy.
- Issue Cancellation and Non-Renewal notices upon request.
- Post direct bill payments into Company billing system.
- Respond to customer billing inquiries and resolve any issues.
- Maintain a consistent quantity and quality of work, at prescribed standards.
- Prepare loss runs and expiration lists as requested by agents.
- Perform other duties as assigned.