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Become A Claims Director

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Working As A Claims Director

  • Getting Information
  • Resolving Conflicts and Negotiating with Others
  • Interacting With Computers
  • Communicating with Supervisors, Peers, or Subordinates
  • Identifying Objects, Actions, and Events
  • Unpleasant/Angry People

  • Mostly Sitting

  • Repetitive

  • Make Decisions

  • $62,980

    Average Salary

What Does A Claims Director Do At Combined Insurance

* Direct and oversee day-to-day activities of the Worksite Claim Service Center to achieve service level objectives and ensure the smooth and efficient delivery of services
* Provide strategic leadership in the development, execution, and monitoring of policies, procedures, and initiatives that align with corporate goals and strategy
* Ensure the claim Key Performance Indicators (KPIs) are measured and monitored and provide overall direction to ensure quality, time service and productivity goals are met
* Oversee claim audit functions for the Worksite Claim Service Center and participate in SOX attestation process and other claim audit activities generated by CHUBB, internal audits and independent auditors.
* Prepare annual expense budgets and manage and provide oversight on expense levels to Claim Strategy and Operations and the NA Operations Finance Team.
* Direct continuous improvement activities/projects of operational processes to increase efficiencies, enhance quality, reduce costs, standardize systems, and/or add value for both internal and external clients
* Collaborate with and maintain a strong partnership with Worksite Operations VP and Sales Leadership team
* Promote a culture of high performance and continuous improvement that values learning and a commitment to quality

What Does A Claims Director Do At Unitedhealth Group

Research, identify and obtain data / information needed to help process claims or resolve claims issues (e.g., verify pricing, prior authorizations, applicable benefits) Ensure that proper benefits are applied to every claim Client-facing interaction with the state Apply knowledge of customer service requirements to process claims appropriately (e.g., Service Level Agreements, performance guarantees) Identify and apply knowledge of new plans / customers to process their claims appropriately Identify and resolve claims processing errors / issues and trends, as needed (e.g., related to system configuration, network, eligibility, data accuracy, vendor-related, provider) Resolve or address new or unusual claims errors / issues as they arise, applying appropriate knowledge or prior experience Communicate and collaborate with external stakeholders (e.g., members, family members, providers, vendors) to resolve claims errors / issues, using clear, simple language to ensure understanding Collaborate with internal business partners to resolve claims errors / issues (e.g., Subject Matter Experts, Network Management, IT / systems staff, Compliance, vendor management teams, contract teams)Document and communicate status of claims / investigations to stakeholders as needed, adhering to reporting requirements (e.g., status letters / reports) Achieve applicable performance metrics (e.g., productivity, quality, TAT) Use appropriate systems / platforms / applications to process claims Navigate systems tools and screens efficiently and effectively (e.g., keyboard skills, macros, shortcuts) Use appropriate documentation, reference materials and / or websites to ensure that claims are processed accurately and efficiently (e.g

What Does A Claims Director Do At Willis Towers Watson

* Provide claims management oversight of all lines of insured claims (workers’ compensation, auto / general / products liability, aviation / marine liability, executive risk, employment practices liability, property / business interruption, etc.) across the organization amounting to over 10,000 reported claims per year with over $120M in total claim dollars.
* Develop and implement programs and cost containment initiatives for internal Claims team and external vendors to bring claims to a prompt and cost-effective resolution.
* Provide guidance and expertise in the evaluation and management of high exposure cases to minimize exposure.
* Manage the third party administrators (TPAs) who handle client WC and casualty claims in the US and Canada.
* Hold regular claims reviews to evaluate performance against business objectives.
* Modify practices and reserves as necessary.
* Coordinate defense of casualty cases through the TPA and outside legal counsel; measure and assess performance of TPAs and company’s performance in meeting goals for reduction in claim experience / cost.
* Ensure compliance with insurance policy requirements as well as company policies / procedures.
* Manage the Managed Care (MC) vendor relationship(s) to ensure appropriate and timely medical management of all WC claims.
* Work with the MC vendor to develop / modify medical networks in states that allow such networks to manage medical costs.
* Collaborate closely with Global Risk Analytics to explore alternative and innovative ways to reduce claim severity by utilizing predictive analytics and other technology solutions.
* Manage the overall Claims budget (~$1
* M annually) to ensure proper fiscal control and monitoring tools are in place.
* Review expense performance to identify trends and validate that appropriate controls are in place and effective.
* Provide periodic statistical analyses of trend data to leadership ; identify and analyze trends and implement resources to minimize adverse trends.
* Effectively manage change and provide clear explanation of the change drivers and business objectives, win acceptance for change and new initiatives to advance the Claims team’s business objectives.
* Build, manage and foster professional development opportunities for the team to maintain and retain bench strength and achieve high levels of business and technical claims expertise within these positions

What Does A Claims Director Do At UNUM

* Maintain overall management responsibility including talent and skill development of team managing pended and active LTC claims.
* Ensure the team provides thorough, fair, and objective claim evaluations and the highest level of quality service to our customers.
* Accountable for accurate administration of risk management programs and adjudication of assigned claims according to contract/plan provisions, established procedures, state regulations and Unum claims philosophy.
* Perform appropriate reviews and quality audit results.
* Ensure appropriate claim documentation of decisions, including appropriate milestone signoff.
* Accountable for total block claim management for assigned LTC claim block, confirming that Unum and generally accepted industry protocols are followed to ensure proper claim decisions are made.
* Ensures that all decisions are accurate; ensures team operates with a sense of urgency with key intervention points including appropriate management of inventory including timely claim transfer to the LTC Extended Duration Unit.
* Develop and maintain strong partnership with internal and external partners including key business constituents to ensure a collaborative working relationship.
* Partner with field and operational teams to share any specific claims trends and experience.
* Maintain client specific workflow and claims administration requirements.
* Facilitate claims escalation issues to resolution.
* Management of external vendor relationships as they relate to assigned customers (e.g., face to face vendors, special investigative unit)
* Assist in the development and management of budget.
* Support the LTC Senior Leadership in developing business plans for the unit and/or department.
* Identify and implement process improvement and quality enhancements while maintaining the highest possible claim management effectiveness in a dynamic environment.
* Ensure operating effectiveness through review of available reports, audit results, customer feedback and survey results and through BCC reports & feedback
* Effectively manage and implement change.
* May serve as back up for LTC AVP during absences

What Does A Claims Director Do At Kforce

Monitoring and tracking of Medicare and Medicaid claims for compliance turnarounds

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How To Become A Claims Director

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator. Higher level positions may require a bachelor’s degree or some insurance-related work experience. Auto damage appraisers typically have either a postsecondary nondegree award or work experience in identifying and estimating the cost of automotive repair.

Education

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator. However, employers sometimes prefer to hire applicants who have a bachelor’s degree or some insurance-related work experience or vocational training. Auto damage appraisers typically have either a postsecondary nondegree award or experience working in an auto repair shop, identifying and estimating the cost of automotive repair.

The varying types of work in these occupations can require different backgrounds or different college coursework. For example, a business or an accounting background might be best for someone who wishes to specialize in claims of financial loss due to strikes, equipment breakdowns, or merchandise damage. College training in architecture or engineering is helpful for adjusting industrial claims, such as those involving damage from fires or other accidents. A legal background is beneficial to someone handling workers’ compensation and product liability cases. A medical background is useful for examiners working on medical and life insurance claims.

Although auto damage appraisers are not required to have a college education, most companies prefer to hire people who have the formal training, experience, or knowledge and technical skills to identify and estimate the cost of automotive repair. Many vocational schools and some community colleges offer programs in auto body repair and teach students how to estimate the cost of repairing damaged vehicles.

For investigator jobs, a high school diploma or equivalent is the typical education requirement. Most insurance companies prefer to hire people trained as law enforcement officers, private investigators, claims adjusters, or examiners, because these workers have good interviewing and interrogation skills.

Training

At the beginning of their careers, claims adjusters, examiners, and investigators work on small claims, under the supervision of an experienced worker. As they learn more about claims investigation and settlement, they are assigned larger, more complex claims.

Auto damage appraisers typically get on-the-job training, which may last several months. This training usually involves working under the supervision of a more experienced appraiser while estimating damage costs, until the employer decides that the trainee is ready to do estimates on his or her own.

Licenses, Certifications, and Registrations

Licensing requirements for claims adjusters, appraisers, examiners, and investigators vary by state. Some states have few requirements; others require either completing prelicensing education or receiving a satisfactory score on a licensing exam (or both).

In some states, claims adjusters employed by insurance companies do not have to become licensed themselves because they can work under the company license.

Public adjusters may need to meet separate or additional requirements.

Some states that require licensing also require a certain number of continuing education credits per year to renew the license. Federal and state laws and court decisions affect how claims must be handled and what insurance policies can and must cover. Examiners working on life and health claims must stay up to date on new medical procedures and the latest prescription drugs. Examiners working on auto claims must be familiar with new car models and the most recent repair techniques. In order to fulfill their continuing education requirements, workers can attend classes or workshops, write articles for claims publications, or give lectures and presentations.

Important Qualities

Analytical skills. Adjusters and examiners must both evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay. Adjusters must carefully consider various pieces of information to reach a decision.

Communication skills. Claims adjusters and investigators must get information from a wide range of people, including claimants, witnesses, and medical experts. They must know the right questions to ask in order to gather the information they need.

Detail oriented. Adjusters, appraisers, examiners, and investigators must carefully review documents and damaged property, because small details can have large financial consequences.

Interpersonal skills. Adjusters, examiners, and investigators often meet with claimants and others who may be upset by the situation that requires a claim or by the settlement the company is offering. These workers must be understanding, yet firm with their company’s policies.

Math skills. Appraisers must be able to calculate property damage.

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Claims Director jobs

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Real Claims Director Salaries

Job Title Company Location Start Date Salary
Claims Director Charles Taylor P&I Management (Americas), Inc. New York, NY Apr 20, 2016 $207,500
Senior Claims Director Thomas Miller (Americas) Inc. Jersey City, NJ Nov 05, 2012 $204,040
Senior Claims Director Thomas Miller (Americas) Inc. Jersey City, NJ Nov 02, 2009 $185,000
Director of Claims Europ Assistance USA, Inc. Bethesda, MD Aug 28, 2013 $91,400
Director of Claims Europ Assistance USA, Inc. Bethesda, MD Jul 12, 2012 $91,400

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Top Skills for A Claims Director

ProceduresGeneralLiabilityClaimsEnsureComplianceLossRatioFinancialClaimsProcessingDefenseCounselAutoLiabilityCustomerServiceClaimsAuditsOversightClaimsAdjustersSuperviseProfessionalLiabilityClaimsBodilyInjuryLitigationManagementSafetyClaimsOperationsMedicalManagementTPA

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Top Claims Director Skills

  1. Procedures
  2. General Liability Claims
  3. Ensure Compliance
You can check out examples of real life uses of top skills on resumes here:
  • Redesigned processes and procedures for managing litigation through the implementation of an aggressive process for managing discovery and case typing.
  • Supervised and directly handles auto liability, commercial truck liability homeowner property / liability, and general liability claims.
  • Conduct periodic audit reviews to ensure compliance with company standards.
  • Analyzed financial data to include: loss adjustment expenses, loss ratio, staffing, payroll and office budget.
  • Identified $1M plus reserve that was not recorded on financial system from third party to carrier.

Top Claims Director Employers

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