Director of LTC Claim Operations, Legacy Business Solutions

Job Classification:

Project Mgmt, Transformation & Strategy - Project Mgmt, Transformation & Strategy

At Prudential, we believe talent is key to achieving our vision. When you join Prudential, you’ll unlock a motivating and impactful career – all while growing your skills and advancing your profession at one of the world’s leading financial services institutions!

Reporting directly to the Vice President of Long-Term Care (LTC) Operations, this role is responsible for overseeing and managing the day-to-day claim operations of the long-term care insurance department. This key leadership role provides strategic & tactical insights and analysis to support business decision-making and drive the achievement of key objectives. This position ensures efficient and effective delivery of insurance services to policyholders, an enhanced customer experience, initiative value accretion and talent development.

The current employee work arrangement for this position is dependent on the business preferences and your location, potentially requiring your on-site presence on occasion at a Prudential office.

What you can expect:

This individual will lead LTC Claim Operations and be accountable for:

• Operational Oversight/Transformation – Responsible for execution of transformation and optimization strategy initiatives associated with the LTC business claim operating model.

• Oversees LTC Third Party Administrators (TPA) claim teams as well as other strategic partners.

• Claims Management – Ensuring timely and accurate claims adjudication. Collaborate with the LTC TPA and internal and external business partners to develop and implement enhanced transformation and consistent process innovation thru predictive analytics within the management of the LTC claim block.

• Drive transformation by identifying opportunities for streamlining operations, increasing efficiency, and improving customer experience.

• Develop and implement strategic claim initiatives based on data analysis to optimize business processes, improve operational efficiency, and enhance overall customer experience.

• Monitor industry trends related to claims management. Actively engage with the industry with the development of LTC best practices, identify areas for process improvement and determine insights that could drive future value.

• Partners closely with legal on all ongoing claim litigation including depositions and serving as a corporate witness.

• Ensure compliance with all relevant laws, regulations, and internal policies governing long-term care insurance operations. Develop and implement controls to meet regulatory requirements and conduct regular audits to assess compliance.

• Provide strategic and technical direction to a Third-Party Administrator (TPA) and other selected vendor partners.

• Responsible for quality assurance program to ensure claims are adjudicated within standards.

• Design and implement dashboards and reports that provide clear and concise visibility into claims handling, trends, and opportunities.

What you’ll need:

• Bachelor's degree.

• 10+ years of management experience, leading through both authority and influence.

• Demonstrated strong leadership and management skills, including analytical, organizational and problem-solving skills, which support sound decision making.

• Proven track record of identifying areas of innovation, opportunity, developing a plan of action, and executing.

• Excellent communication skills, with the ability to present complex information and insights in a clear and concise manner to senior leadership and key stakeholders.

• Strong analytical skills and ability to translate complex data into clear and actionable insights.

• Demonstrated project management skills, with the ability to prioritize and manage multiple priorities simultaneously.

• Must have flexibility and ability to adapt to changing priorities and ambiguous environment.

• Highly self-motivated and able to thrive in an extremely fast-paced and changing environment.

It’d be a plus if you had:

• CLTC or LTCP designations a plus not required.

• MBA degree is a plus.

• 5+ years of long-term care experience and knowledge of product features and deep knowledge of the industry’s regulations and solutions/capabilities a plus

• Knowledge of principles, methods and techniques of long-term care insurance claims management a plus.

• Oversight or experience with TPA and other vendor management experience a plus.

• Experience in vendor contract negotiations and