VP Claims - Compliance, Audit & Training

Company Details

 

 

Vela Insurance Services provides specialized Excess and Surplus Lines Casualty and Professional Liability insurance solutions in the following four market segments.: Construction, Specialty Casualty, Velocity Smal Business & Professional Liability.  We offer national service and local knowledge to our exclusive wholesale broker network and the businesses they serve.

 

Responsibilities

The VP Claims Compliance, Audit and Training is responsible for compliance, audit and training oversight for the claim department. This position will ensure all adjusters, managers and support comply with all Best Practices, quality and standards set forth by the company. They will also be responsible for maintaining and acting on any internal and external audit findings and required actions in conjunction with claim leadership.

• Participate in development and support of strategic plan for Claims. 
• Work closely with compliance departments within Vela and WRBC as needed, maintaining SOX Control reporting, narrative reporting, other reporting as requested. 
• Identify, promote and train on Best Practices Claim Handling.  Provide technical oversight and direction to Claims team. 
• Perform structured audit and reviews of claim files to assure that they meet defined Best Practices and file quality standards as defined by internal and external requirements and the Claim Handling Guidelines, in an objective and consistent manner for the Claims Department.  Complete assigned audits accurately and within a set time period. 
• Identify, document and assess the audit and/or file review providing an executive summary. Conduct and document quarterly file reviews.  Track manager open file reviews and provide reporting.  Claim file reviews will address opportunities to improve and provide feedback in a positive learning environment, with the goal being continuous improvement.   
• Support the execution of SOX Claim Compliance including reviewing claim Best Practices, SOX Claim Narrative and making changes where necessary.  This also includes testing of SOX claim controls (QA, Large Loss, P&P’s, SOPs, Best Practices and Claim Authorities).  This includes the set-up of procedures and processes required for improving WRBC audit results. 
• Review and maintain claim letter of authorities and review with Claims Director for appropriateness including the manual claim letter control and accomplish through automated claim system. 
• Conduct calibration discussions with managers to ensure the Claim Department has consistency in understanding and application of file accuracy. 
• Develop and perform training and education needs for the claim department including new hire training.  Organize and maintain monthly CE training opportunities for the claims department. 
• Manage Litigation Management Department. Provide oversight and management of litigation process and procedure, billing and panel counsel in collaboration with the VP of Claims and Litigation. 
• Acts as a liaison in regard to trial reporting to claim leaders, WRBC and monitor arbitration and trial dates for the claim division including conducting pre-trial meetings monthly. 
• Track litigation, arbitration, mediation, trial dates, settlement and trial results and findings.   
• Conduct meetings and training sessions, as necessary, on progress of audit/compliance matters as follows: Training/Education, Audit Progress, Pretrial Meetings, Committee Meetings, Metric Development, SOX Claim Compliance.   
• Review and document other claim metrics as requested, including but not limited to Reserve Reviews and reports, reserve change cadence reports (time driven,) file activity reports, etc. 
• Works with outside auditing team, KPMG or others in providing claim documentation for external audits.   
• Work to build and enhance collaboration amongst claims leadership, teams, underwriting, technical and support staff in an affable way.  Present to internal and external partners as needed. 
• Regular and predictable attendance
• Other duties as requested. 

 

Qualifications

• Four (4) year College Degree 
• JD preferred but not required. 
• Adjuster licenses in required states. 
• Insurance Designations preferred but not required. 
• Proficient in Best Practices claims handling process, including all product lines and coverages. 
• Experience working with Departments of Insurance, Regulatory Requirements, Compliance and Market Conduct Studies. 
• Complex knowledge of coverage, litigation and resolution of multiple lines of business. 
• Thorough knowledge of policies, procedures and claims handling processes. 
• Proficiency in claims technical areas:  Coverage and liability assessment in all lines of