Director - Technical Claims

BASIC PURPOSE:

 

Serve as technical advisor to the Claims Department with a focus on Casualty claims.  Provide technical guidance and strategic oversight to claim handlers, claim leaders, and Corporate Management as appropriate, on claim files with large financial exposure or complex liability or coverage issues.  Collaborate with file handlers, managers and management to ensure that large loss exposures are investigated, evaluated, reserved, discussed internally and resolved proactively thorough investigation, exposure analysis, establishment of timely reserves, development and implementation of claim handling, resolution strategies, and partnership with all stakeholders for the best total claim outcome.  Ensure appropriate claim files are managed, selected, and prepared for resolution, hearing, trial, or other settlement forums.  Identify and assist in preparing and delivering key technical training programs to Claims staff.  This position does not have responsibilities in connection with Workers Compensation or Property claims.

 

PRIMARY JOB RESPONSIBILITIES:

 

• Collaboration with supervisors/managers/directors may include the following:
• Consultation in connection with staffing decisions, to include interviewing and onboarding for new employees.
• Training and development, as well as coaching for staff.
• Performance management, goal setting, and employee engagement.
• Provide file handling guidance, direction, and resolution strategy on complex cases that exceed claim handler authority in full alignment with achieving outcome accuracy, adherence to jurisdictional compliance requirements, and support execution of all department best practices.
• Provide internal claims coverage analysis on all CM Group policy forms, including CM Group subsidiaries. Manage complex referrals and coordinate with Corporate Legal and the Claims Department as needed.
• Collaborate with file handlers, managers and co-directors to assure large exposures are thoroughly and timely prepared for roundtable presentations.
• Review and report on large exposure claims heading to trial including results.
• Provide analysis and opinions regarding state legal issues impacting claim analysis (e.g., potential risk transfer, joint and several liability, charitable immunity, wrongful death, and specific venue-based issues).
• Partner with Claims Management, Claims Technical Coach, and Learning and Development to provide technical claims training, as well as jurisdictional specific training that is in full alignment with the department training plan and strategy.
• Conduct technical file reviews of the department's most complex cases, aged pending cases, or other files as requested.
• Partner with Claims audit staff to ensure alignment and consistent execution of best practices and identification of additional training needs.
• Advise and mentor Claims staff concerning the proactive investigation, evaluation, or negotiation of complex claim files.
• Review and approve complex coverage denials and reservation of rights letters.
• Ensure all cases that will be tried, go to a state hearing process, or other form of settlement or dispute resolution, are properly selected and prepared prior to the initiation of this process. This includes following best practices, ensuring cases are properly reserved, and all communication protocols have been followed.
• Consult on compensability decisions and provides technical input and strategic recommendations during case reserving, settlement authority and pretrial roundtables/conferences, with follow-up communications to senior management as appropriate.
• Ensure proper execution and utilization of all applicable loss mitigation, cost containment, and litigation management strategies.
• Coordinate with Claims Legal in maintaining the outside panel counsel list, adding or removing firms as necessary for corporate needs and identifying firm specialty practices. Monitor and evaluate firm performance.  Negotiate rates with the law firms and cause updated rates to be reflected in Legal Exchange.
• Assist in the improvement of metrics utilized to track counsel/firm performance.
• Assist Claims Legal with claim related litigation or direct corporate litigation, including extra contractual claims, E&O claims, and other litigation as directed by Church Mutual General Counsel.
• Serve as a liaison for communication between outside counsel