Director of Claims

Role Summary:

The Director of Claims oversees the strategic and operational management of the claims department, ensuring fair, timely, and effective resolution of member claims. The Director will supervise internal claims adjusters, collaborate with legal counsel and members on coverage determinations, and manage third-party adjusters. This position plays a key role in shaping claims policies and procedures and contributes to the broader strategic goals of the organization.

Essential Functions:

Claims

• Regular and reliable attendance in-person or virtually is required 5 days per workweek
• Must be available to attend in-person meetings as requested by their supervisor
• Supervise and/or manage each claim submitted to Enduris, from inception to the settlement, including a preliminary coverage assessment, liability and damage determination, reserve assessment, and recoveries.
• Supervise the Claim staff and administrative staff supporting claims.
• Work with the members and legal counsel to determine coverage and find coverage when possible
• Develop and recommend Claims policies and procedures to the Executive Director
• Develop and maintain the Claim Management Guidelines Manual
• Manage and oversee the work of Third-Party Claims adjusters
• Manage all aspects of claims, including investigating, evaluating, and settling claims
• Settle claims within the authority set by the Executive Director and/or the Board of Directors
• Obtain authority from the Executive Director, Board of Directors, and/or reinsurer to settle claims above the authority limit
• Coordinate and oversee communication regarding claim concerns with the Claims Associates, Financial Services Coordinator, Chief Operating Officer, and the Executive Director
• Work with the members to resolve disputes that may lead to a claim, and work with members to mitigate any potential claim
• Coordinate Reservation of Rights and Denial of Coverage Letters to Members
• Designate and manage claims on the ‘watch list’
• Manage Origami (the claims information system)
• Oversees verification and documentation of Medicare eligibility as required for Medicare reporting under Section 111

Litigation

• Supervise and/or manage litigation of all claim files
• Attend mediations, settlement conferences, depositions, arbitrations, and trials as necessary
• Oversee and manage Defense Counsel and supervise and/or establish a litigation strategy, including approval of claims budget for each litigated file
• Manage defense counsel’s compliance with Enduris policies, procedures, and/or guidelines
• Oversee the selection of Defense Counsel
• Schedule independent claims audits

General Administration

• Oversee the status and condition of claims files
• Review and analyze reinsurance/excess policies from the broker
• Evaluate, coordinate, and implement changes in the Memorandum of Coverage
• Regularly attend and participate in management meetings and staff meetings
• Attend appropriate conferences and meetings as a representative of Enduris
• Advise and assist with the development of claims and risk management training for members
• Accept, develop, and implement special projects as assigned

Accounting and Finance

• Work with the Director of Finance, the Actuary, and the Financial Services Coordinator for claims accounting and/or reconciliation
• Prepare and manage claims files for the audit review and financial data
• Coordinate loss revenues and expenses with the Financial Services Coordinator
• Assist and make recommendations in the budgeting process

Other duties as assigned

• Performs other duties as assigned

Required Skills/Competencies:

• Leadership
• Managing a diverse team
• Negotiating
• Performing mathematical calculations
• Analyzing data and using data to make decisions
• Reviewing, organizing, writing, and presenting reports

Physical Activities / Working Conditions:

• Working hours of 8AM-5PM M-F
• Occasional travel, evenings, or extended hours may be required
• Office environment, interacting with other employees in person or virtually
• Ability to sit, stand, communicate, and use office technology for extended periods
• Excellent written and verbal communication skills

Qualifications:

• BA in Business or related field
• 15 or more years as a claim professional; prefer some supervisory or management experience
• Experience with high-severity, bad-faith exposure cases and coverage disputes
• Five years of experience in multi-line claims adjustment and coverage analysis
• Expertise in applying critical thinking and analysis of complex issues
• Extensive knowledge and experience in litigation management
• Proficiency in effectively communicating complex issues and managing complex situations
• Ability to travel via car and airplane for overnight business travel
• Proficient computer skills: MS-Office, Excel, and Origami (claims system)
• Capable of working well with others, including the management team, co-workers, members, and service providers

• Professional certifications (highly preferred / often required):
  • CPCU (Chartered Property Casualty Underwriter)
  • ARM (Associate in Risk Management)
  • AIC (Associate in Claims)
  • SCLA (Senior Claims Law Associate)
  • State insurance adjuster licenses (multi-state if applicable)