Claims director job description

James River Insurance is an excess and surplus lines segment of James River Group Holdings, Ltd. and operates on an approved non-admitted basis in 50 states and Washington, DC. Since 2003, James River has provided thousands of commercial property and casualty customers with innovative and creative solutions for particular insurance needs.

At James River Insurance, we are committed to providing a stable and rewarding work environment supported by our Core Values and Guiding Principles: Integrity, Accountability, Innovation, Customer Service, Communication, and Teamwork. We are proud of our recent national recognition as a 2022 and 2021 Top Workplaces USA awards.

James River Group Holdings, Ltd. is a Bermuda-based insurance holding company which owns and operates a group of specialty insurance and reinsurance companies. The Company operates in three specialty property-casualty insurance and reinsurance segments: Excess and Surplus Lines, Specialty Admitted Insurance and Casualty Reinsurance. The Company tends to focus on accounts associated with small or medium-sized businesses in each of its segments. Each of the Company's regulated insurance subsidiaries are rated "A-" (Excellent) by A.M. Best Company.

Job Summary

The Director, Complex Claims is responsible for the oversight of a sub-unit within the claims organization that directly handles or provides guidance on the most complex claims defined as claims of significant value, or complexity, or within a specialty line of business and litigated claims that may involve catastrophic injuries, life altering disabilities or multiple fatalities (Examples: NY Labor Law, robberies involving fire arms, sexual abuse charges, product and construction defect claims). The Director, Complex Claims ensures that the Company achieves the best possible outcomes on complex claims and lawsuits brought against Policyholders.

Duties and Responsibilities

• Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service

• Monitor complex claims frequency, suits, trends and caseloads for department

• Counsel management on legal risks, claim and litigation strategy and obligations in complex claims and lawsuits

• Oversee the investigations of the most complex claims, including liability and damages

• Participate in determining claim strategy, including if a claim should be settled or litigated ensuring adequate reserves and cost-effective resolutions

• Develop and direct the execution of the litigation management strategy including litigation by outside counsel representing James River on coverage issues

• Provide insight and help develop legal positions by conducting research and legal analysis and by providing clear direction on complex legal or claim handling questions or issues

• Direct the negotiation of the most complex settlements

• Attend mediations ensuring adequate reserves and cost-effective resolutions

• Research and track legal and regulatory developments and advise management and claims professionals regarding issues, approaches and the impact of changes

• Participate with Claims senior management in the recommendation and development and implementation of claims policy, business strategy and future technology enhancements involving complex claims

• Utilize complex claims experience to assist Underwriters in writing specific coverage to meet needs of high-profile clients

• Provide status reports to claims management, actuarial, and underwriting on complex claims with high dollar values and noteworthy media coverage

• Manage to and make recommendations on an operating budget for the complex claims unit

• Participate with the claims leadership team on the development of one, three and five year plans for the claims organization

• Ensure that project and department milestones and goals are met

• Interview, select and train new employees

• Guide and help team members with project issues

• Responsible for day-to-day tactical team decisions

• Track employee performance and provide regular and appropriate feedback

• Work with employees to collaboratively establish development plans

• Provide employee feedback through regular check-ins and writing and delivering performance reviews

• Lead team through obstacles and time constraints to overcome barriers and successfully deliver results

Knowledge, Skills and Abilities

• Advanced knowledge of the theories, principles, practices and procedures of claim and litigation management within an insurance organization

• Advanced knowledge of E&S insurance products

• Proficiency in MS Office (Word, Excel, Outlook)

• Ability to effectively communicate with all levels of the organization

• Excellent written and verbal communication skills

• Strong negotiation skills

• Skilled in active listening

• Excellent presentation skills

• Excellent organizational skills

• Strong analytical skills

• Ability to prioritize and handle multiple tasks in a fast-paced environment

• Ability to organize complex information and pay close attention to detail

• Ability to identify and make process and procedure improvement recommendations

• High level of initiative and motivation

• Ability to build relationships and influence decisions

• Ability to maintain confidentiality when performing all job functions

• Demonstrated ability to lead teams in building effective working relationships

• Demonstrated ability to lead, motivate, influence and mentor staff

• Ability to set clear expectations, effectively monitor progress, provide constructive feedback and guidance, and hold staff accountable

• Ability to effectively plan and delegate the work of others

• Ability to effectively manage change

• Proven ability to provide exceptional customer service

• Ability to obtain and retain required adjuster licenses

• Ability to travel

Experience and Education

• Bachelor’s Degree required

• Advanced degree, law degree plus State Bar Admission preferred

• Minimum of ten years of experience working on complex coverage-related insurance claims in the P&C insurance industry and/or as defense counsel on complex E&S- general casualty claims required

• Minimum of five years multi-jurisdictional claims and litigation experience required

• Minimum of five years of people management experience (supervision, mentor, lead) required

• Adjuster license required

• Certifications (CPCU, AIC, AINS, SCLA) preferred

#LI-KS1

#LI-Remote

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Provide direction and oversight for the operations of the Claims organization within established enterprise, state, and federal compliance guidelines with a focus on continuous improvement.

Develop workforce strategy that attracts, retains, and develops talent that meets the evolving needs of the organization.

Safeguard the successful maintenance of all claims processing activities and standards within established compliance, timeline, and quality guidelines.

Collaborate and coordinate with key stakeholders to ensure dependencies are well understood and addressed within the Claims organization and allow success in operational objectives.

Act as a key driver for change to support growth initiatives and continued business improvement and transformation.

Use data, technology and innovation to drive continuous improvement to identify, assess and resolve issues across Claims.

Serve as escalation point to minimize customer impact and ensure that customer expectations are consistently met.

Education/Experience: Bachelor's degree in Business, Healthcare Management or related field. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff required. 7+ years of Claims Operations management required. Experience leading large-scale efforts (change, implementation, digital/technology, financial management) through data analysis and insights required. 5+ years of healthcare experience in multiple areas of Operations (Claims, Provider/Member Services, Medical Management, Network/IT, etc.) preferred.

Certifications: Project Management Professional Certificate (PMP) and/or Lean Six Sigma Certification (e.g. green belt, black belt, master black belt or other) preferred

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
**TITLE:** Director, Claims Operations

**LOCATION:** Woodland Hills, California

**REQNUMBER:** 1365086

Chubb is the world's largest publicly traded property and casualty insurer. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.
Responsibilities:

Duties may include, but are not limited to:

* Providing outstanding customer service and working well with insureds, brokers and TPAs in the handling of construction casualty claims
* Analyzing coverage issues and communicating coverage positions to business partners and insureds, as warranted
* Directing all aspects of litigation from inception through appeal including: oversight of assignments to experts and defense attorneys, reserve setting, negotiating and settling of claims
* Evaluating and analyzing coverage, liability, and damages to determine the extent of exposure to the insured and the company
* Reporting to reinsurers the prompt collection of any reinsurance
* Traveling to conferences, mediations, and trials as necessary
* This position reports to a line of business Assistant Vice President and other senior claims leaders
* Adept at negotiations and conflict resolution

Minimum Requirements:

* Should have a high degree of specialized and technical competence in the handling of casualty claims with particular emphasis on General Liability and OCIP/CCIP policies
* Minimum of 5 years construction claim handling experience, with experience handling New York Labor Law claims
* College degree or equivalent business experience, J.D. preferred
* Ability to multi-task
* Excellent interpersonal communications and negotiation skills
* Ability to work with TPA's and large accounts in a professional manner

Desired Qualifications:

* Should have a high degree of specialized and technical competence in the handling of casualty claims with particular emphasis on General Liability and Business Auto policies
* Experience in handling claims in all 50 states
* Adept at negotiations and conflict resolution.

Chubb strives to offer a diverse and inclusive and rewarding work environment. Teamwork and mutual respect are central to how Chubb operates and we believe the best solutions draw upon diverse perspectives, experiences and skills. We operate in such a way where everyone, regardless of their singular background has the opportunity to contribute to our collective success.

Chubb offers a competitive compensation package and comprehensive benefits package including life, health and dental, vision, a generous retirement savings plan, disability coverage, stock purchase plan, flexible spending accounts, tuition reimbursement, and business casual dress. At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religion, age, sex, sexual orientation, transgender, national origin, disability, genetic information, veteran, or marital status, or any other characteristic protected by law.

EEO Statement

At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.