Director of Claims

Jobless; Northern (KY); Hybrid; USD 120,000 - 180,000; Full time

Job summary

Get Covered LLC in Kentucky is seeking a Director of Claims to lead the Master Policy TLL and Contents Claims program, directing a team of claims adjusters and ensuring regulatory compliance. This senior role requires extensive claims adjustment experience and a proven leadership track record.

You will oversee complex claims, implement best practices, and collaborate with partners to drive efficiency and favorable outcomes.

Qualifications

• Bachelor's degree in Business Administration, Insurance, Risk Management, or related field; advanced degree or professional certifications (e.g., CPCU, AIC) preferred.
• 7-10 years of experience in claims adjustment, with 3-5 years in a managerial role; experience may substitute education requirements.
• Demonstrated experience managing a team of claims adjusters.
• Strong understanding of claims regulations, notices, payments, and processing.
• Proven track record in handling claim disputes, DOI complaints, and legal depositions.
• Excellent leadership, communication, and interpersonal skills.

Responsibilities

• Lead, mentor, and manage a team of claim adjusters handling Master Policy TLL and Contents Claims.
• Oversee adjustment, processing, and resolution of complex claims in compliance with regulations and company policies.
• Maintain understanding of claims regulations, notices, payments, and processing; stay updated on regulatory changes.
• Handle complex claim disputes; escalate issues; manage DOI complaints and participate in depositions as required.
• Develop and implement strategies to improve departmental efficiency and build strong external partnerships.

Job description

About the role

• As the Director of Claims, you will play a pivotal role in overseeing and directing the claims management process for our Master Policy TLL and Contents Claims. You will be responsible for leading a team of claims adjusters, ensuring compliance with regulations, and handling complex claims and disputes. This position requires a blend of leadership skills, extensive claims adjustment experience, and a deep understanding of claims regulations and processes.

What you'll do

• Leadership and Team Management:
  • Lead, mentor, and manage a team of claims adjusters handling Master Policy TLL and Contents Claims.
  • Foster a collaborative and high-performance work environment.
  • Provide ongoing training and development opportunities to team members.
• Claims Management:
  • Oversee the adjustment, processing, and resolution of complex claims.
  • Ensure all claims are handled in accordance with regulatory requirements and company policies.
  • Review and approve claims decisions and settlements.
• Regulatory Compliance:
  • Maintain a strong understanding of claims regulations, including notices, payments, and processing.
  • Ensure compliance with state and federal regulations and guidelines.
  • Stay updated on changes in regulations and implement necessary adjustments to procedures.
• Dispute Resolution:
  • Handle complex claim disputes and
  • Escalate issues as necessary.
  • Manage DOI complaints, ensuring timely and effective resolution.
  • Represent the company in depositions and other legal proceedings as required.
• Department Development:
  • Develop and implement strategies to improve departmental efficiency and effectiveness.
  • Build and maintain strong relationships with external partners and stakeholders.
  • Analyze and report on claims trends, performance metrics, and opportunities for improvement.

Qualifications

• Bachelor's degree in Business Administration, Insurance, Risk Management, or a related field; advanced degree or professional certifications (e.g., CPCU, AIC) preferred.
• Minimum of 7-10 years of experience in claims adjustment, with at least 3-5 years in a managerial role. Experience may be substituted for education requirements.
• Demonstrated experience managing a team of claims adjusters.
• Strong understanding of claims regulations, notices, payments, and processing.
• Proven track record in handling claim disputes, DOI complaints, and legal depositions.
• Excellent leadership, communication, and interpersonal skills.

About Get Covered LLC

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