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Responsible for oversight of claims personnel and handling of claims by third party administrators to ensure appropriate and timely resolution of claims in alignment with Core Specialty Financial Services Division appetite and standards. Execution of Financial Services business plans and objectives.
Key Accountabilities/Deliverables:
Ensure TPAs and internal employees comply with established claim handling guidelines regarding coverage, investigation, liability, damages, evaluation and resolution.
Collaborate with audit team to develop and maintain claim audit plans, checklists, and reporting tools tailored to the performance standards required by the organization.
Identify and document performance issues, process gaps, and compliance violations; recommend corrective actions and track resolution progress.
Monitor TPAās adherence to service level agreements (SLAs) and claim resolution timelines.
Evaluate the accuracy and appropriateness of claim payments, reserves, and denials made by the TPAs.
Gather and analyze information to make an accurate evaluation of claims by delivering effective resolution of claims, make decisions within established authority levels and identify settlement issues.
Establish and review reserves pursuant to reserving protocols and reserve authority procedures.
Monitor performance of claims by review data, reports and sharing information with the division regularly. This includes performing reserve reviews on a quarterly basis and communicating results with underwriting team to share claim trends.
Provide input on TPA contract negotiations, ensuring terms support robust oversight and accountability.
Work with external customers to address questions, resolve problems and maintain rapport.
Proactively expand and maintain awareness of market and industry
In addition to the above key responsibilities, you may be required to undertake other duties from time to time as the Company may reasonably require.
Technical Knowledge and Understanding:
Knowledge of targeted industries
Knowledge of insurance company operations
Knowledge of financial services products including coverages, exclusions and endorsements
Knowledge of state and federal laws applicable to financial services claims.
Detailed understanding of good faith claims handling and legal principles pertaining to insurance claims.
Ability to simplify, analyze and explain complex issues
Ability to review processes and determine opportunities for improvement
Experience:
Bachelorās degree (preferably with a Risk Management & Insurance Major) required
Achieve or working towards an industry designation such as CPCU, CRM, ARM, CIC
Minimum of 5 yearsā experience in claims resolution across the applicable lines of business
Experience working with support services, including IT, claims, actuarial and operations.
Applicants must be authorized to work for any employer in the U.S.Ā We are unable to sponsor or take over work authorization sponsorship now or in the future for this position.Ā
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At Core Specialty, you will receive a competitive salary and opportunities for professional development and advancement.Ā We offer medical, dental, vision, and life insurances; short and long-term disability; a Company-match of 100% of a 6% contribution 401(k) plan; an Employee Assistance Plan; Health Savings Account, Flexible Spending Account, Health Reimbursement Account, and a wellness program
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