Director, Claims Work Comp and MI PIP

Frankenmuth Insurance Company; United States; Presencial; USD 90.000 - 130.000; Jornada completa

Descripción de la vacante

Frankenmuth Insurance Company seeks a Claims Supervisor to oversee Workers’ Compensation and MI PIP claims with substantial independent judgment. You will direct claim handling, establish strategies for complex, high-exposure, and litigated claims, and ensure timely resolution and cost control.

In this leadership role, you will manage a team, set performance expectations, and collaborate with defense counsel, medical reviewers, and internal partners.

Formación

• Experience supervising workers' compensation and MI PIP claims.
• Ability to develop strategies for complex, high-exposure, and litigated claims.
• Experience in budgeting, staffing, and process improvement.

Responsabilidades

• Oversee management and resolution of Workers’ Compensation and PIP claims.
• Establish claim-handling strategies for high-exposure and litigated claims.
• Ensure timely investigation, reserving, medical management, and settlement or litigation planning.
• Build relationships with counsel, vendors, and internal partners.

Educación

Six to ten years in a related role

Descripción del empleo

Summary

Under limited supervision and with significant independent judgment, supervises and directs the handling of workers' compensation and MI PIP claims by performing the following duties:

Essential Duties and Responsibilities

1. Provides claims oversight and management expertise, including:
   1. Oversee the management and resolution of all Workers’ Compensation claims (including non-litigated and litigated claims), and non-litigated PIP claims.
   2. Establishes claim-handling strategies and provides direction on complex, high-exposure, catastrophic, disputed, and litigated Workers’ Compensation claims.
   3. Ensures appropriate investigation, evaluation, reserving, medical management, negotiation, litigation strategy, and timely claim resolution.
   4. Recommends defense counsel. Monitors and evaluates defense counsel’s performance, rates, and geographic areas covered.
   5. Oversee Medical Bill Review for Workers’ Compensation and PIP, including quality, cost containment, vendor performance, and compliance.
   6. Maintains effective workflows and promotes consistent delivery of a high-quality work product.
   7. Monitors claim outcomes, reserve adequacy, litigation results, medical costs, quality, productivity, and customer service.
   8. Ensures compliance with applicable laws and regulations, fair claims handling practices, internal standards, and authority guidelines.
   9. Identifies trends and implements improvements to claim outcomes, processes, service, and operational performance.
   10. Participates in budgeting, staffing, workload planning, and resource allocation.
   11. Builds effective relationships with defense counsel, vendors, agents, policyholders, and internal business partners.
2. Functions as the manager of employees within a major organizational business unit, generally through subordinate leaders, including:
   1. Communicates vision, priorities, performance expectations, and organizational goals.
   2. Develops and recommends strategic and operational plans and organizes resources to achieve business results.
   3. Trains, coaches, develop, and leads staff.
   4. Oversee performance management, including performance planning, appraisal, employee development, and corrective action.
   5. May recommend and/or implement employment actions, including employment/termination, corrective action, promotions/demotions, salary changes, etc.
3. Performs other duties as assigned.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience

Level 6: Six to ten years in a related role, or equivalent combination of education and experience.

Certificates, Designations, Degrees, and Licenses

CPCU Preferred