Director, Claims Operations, REMOTE

This position requires residency within the US.  Business hours: EST or CST.  
REMOTE opportunity 

SUMMARY:   

This role is responsible for planning, organizing, directing, controlling and leading strategy, performance and operations within Corporate Claims. This role will set the vision and identify strategic direction for claims operations throughout the Enterprise. This role will support corporate goals and objectives and direct activities of planning, staff development, problem solving and communications. This role will establish business unit’s goals and objectives that support continuous quality improvement, manage and develop business unit leadership and provide effective/efficient solutions to complex business problems. This role provides a high level oversight and leadership to business unit and leads change effectively.

RESPONSIBILITIES/TASKS: 

• Responsible for Claims Strategy throughout the Enterprise .
• Oversight of claims systems and processes including Enterprise Way and Target Operating Model
• Responsible for formulating large scale, current and multi-year plan strategy development in a dynamic and evolving environment.
• Leads change management efforts within claims functions.
• Manages claims customer experience and strategy.
• Execute and continuously improve end-to-end process model operations.
• Construct and execute data driven performance management of processes, programs, vendors, staff and providers. Conduct operations in a planned, metric-driven approach.
• Provide vision, leadership, planning, project coordination and management for the development of a cost-effective department while concurrently facilitating efficient operations to meet current and future business needs within the organization.
• Partner and guide clients and key customer contacts through a continued process improvement effort to better engage members and providers in the Quality space
• Responsible for establishing and oversight of claims training strategies and programs.
• Upon request, function as the department head in the absence of the Executive of the area.
• Participate in the development of programs as a strategic partner that supports the company plan.
• Participate in development of annual departmental budget, monitor budget and identify budget discrepancies.  Research cause and make recommendations.
• Responsibility for balancing workload to optimize the effectiveness of the department.
• Liaison to Data and Analytics.

DIRECTION EXERCISED: 

Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws.  Responsibilities include but are not limited to effectively interviewing, hiring, terminating, and training employees; planning, assigning and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.

This position description identifies the responsibilities and tasks typically associated with the performance of the position.  Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor’s degree in a related field. Continuous learning, as defined by the company’s learning philosophy, is required.  Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

Ten years of progressively more responsible experience in an insurance environment with demonstrated technical experience that provides the necessary knowledge, skills and abilities. Five years of experience in claims management including leadership experience implementing new claims programs. Five years of leadership experience in an insurance company. 

 SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: 

• Excellent analytical, organizational and problem solving skills and senior level skills in managing ambiguous and time sensitive situations and issues.
• Knowledge of activities, practices and terminology of the insurance industry, preferably workers compensation.
• Strong strategic planning, program development and project management skills. Ability to think ahead and plan over a 3 to 5 year span.
• Ability to negotiate and establish a personal rapport with opposing parties, and to resolve conflicts in a professional manner. 
• Knowledge of workers’ compensation statutes and workers’ compensation filing procedures, medical terminology and various settlement methodologies.
• Advanced technical knowledge of insurance administration, claims