Job Description
As Director of Complex Claims, you will be responsible for the technical and operational performance of teams within the complex claims department. You will have direct supervision of managers and/or supervisors to ensure deliverables and objectives are met and appropriate staffing and productivity levels are maintained. The Director of Complex Claims manages multiple teams handling complex claims to meet service level requirements. The candidate will work closely with, and support the Vice President of Claims on the execution and development of technical and operational direction of the complex claims department.
1. Responsible for guidance and direction to the complex claims team with technical expertise including: policy language interpretation, complex investigations, appropriate application of coverage, reserving accuracy, claim resolution, and compliance to our internal and customer standards.
2. Oversee all functional aspects of the claim operation. Directs the work activities and has full management responsibility for the performance and development of assigned staff in accordance with corporate strategic direction and customer guidelines.
3. Cultivate positive working relationships with all other areas of the operation, including Underwriting and Sales.
4. Develop and lead claims round table discussions to confirm verifiable damage and a plan of action.
5. Provides guidance for appropriate estimate review, policy coverage application, and major case evaluations.
6. Liaises effectively with agents, policyholders, Underwriting, and Claims Management.
7. Manages relationships with business partners and/or vendors. Serve as a subject matter expert on all client specific guidelines, specifications, policies and procedures.
8. Reviews and directs the application of claims policy and effectively manages claims amounts within that policy.
9. Keeps abreast of changes in legislation and regulations pertaining to property insurance claims.
The Director of Complex Claims is responsible for oversight of the claims managers and claim handlers to achieve timely and effective disposition of claims in accordance with the available coverage and applicable procedures, laws and regulations.
The successful candidate will have a minimum of ten years of experience handling complex property claims and a minimum of 5 years of management experience handling Florida homeowner property claims.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
- Reviews detail of claims under applicable policy for first-party property losses to determine insurance coverage, effective dates, policy limits and exclusions. Identifies, monitors, and resolves coverage issues, with assigned claims manager. Reviews and assigning claims to the appropriate claim handling unit as determined by the details of the claim as reported.
- Reviews and authorizes the establishment of appropriate claim reserves to ensure that future claim costs are accurately assessed, and the company can determine its financial position.
- Directs and manages Unit Manager activities. Reviews managers reports for accuracy and determination of details of loss and coverage for same.
- Reviews the file with assigned manager, as warranted/requested based on coverage concerns, files that exceed manager authority, multiple losses reported and any red flag issues. Reviews and approves reserves in accordance with clients guidelines. Compares loss claimed to policy coverage and refers claims to the VP of Claims if loss exceeds Director's authority levels.
- Directs and coaches claims managers and staff where necessary with regard to the claim investigation, use of experts, use of available technologies to further investigate, document and resolve losses and guidance on coverage issues that require resolution.
- Communicates with agents regarding status of claim, when necessary.
- Reviews, approves or elevates reserves, reservation of rights letters, payment explanation correspondence, denial letters, or partial denial letters, as applicable.
- Assists in the resolution of claims disputes where necessary. Responsible for re-evaluating claim, as necessary.
- Participates in litigation when applicable.
EDUCATION and/or EXPERIENCE - Bachelor's degree
- In-depth professional knowledge of all aspects of claims operations.
- A minimum of 5 years of management experience.
- Claim litigation experience
- Florida 520/620 license is required.
- Ability to obtain AL, GA, NC and SC adjusters licenses.
- Strong personal lines coverage interpretation and claims handling background is required.
- Must have residential construction knowledge and be proficient in Xactimate.
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