Keolis North America
Senior Director of Claims
Keolis North America, Boston, Massachusetts, us, 02298
Location:
BostonSkillsProcess Design / Management and ReportingStrong Customer Service skills and ability to influence othersAbility to engage cross functionally in support of strategic business goalsEffective communication with multiple levels of the organization including executive leadership as well as with vendors / claimants as needed.Sound decision making skills having practical sense of escalation needsEffective leadership skills with ability to motivate team members / vendors / peersDetail oriented with solid ability to apply analytics to decision making and KPI developmentKnowledge and ExperienceExperience designing and leading claims management programsExperience in partnering with Legal, TPA and Insurers for effective claims litigation managementFinancial acumen in liaising on actuarial studies and accrual managementDemonstrated knowledge of best practices in claims managementExperience developing educational materials to communicate / educate program stakeholdersKnowledge of RMIS systemsProficiency in Microsoft Office Programs - Word, PowerPoint, Excel7+ years of Insurance and Claim ManagementEducationBachelor’s DegreeProfessional Certifications / Designations such as CIC, ARM, CRMP, CPCU preferred.Key AccountabilityClaims Process ManagementWork with location and TPA to ensure effective processes of preservation / collection of all pertinent documentation including videos, recordings, etc. for investigationsPartner with TPA to evaluate and develop strategies for prompt resolutionCollaborate with In-House Legal with respect to litigated claims and settlement activitySeek and maintain best practice claim management processes (e.g., prompt claimant contact, expression of empathy; resolution strategy development; prompt resolution)Interact routinely with internal and external customersOversee the development of monthly claims reports in partnership with TPA and or financial analyst. Present to various audiences including CEO.Meet monthly with TPA for program status, needs, trends, action plan updatesCollaborate extensively with stakeholders related to safety, risk mitigation, and claim reductionReview claim reports and determine defense/development and provide feedback to TPA to develop strategy for resolution taking accident/event severity; known facts and venueReview reserve needs with TPA for appropriateness, presenting changes to the Reserve Committee with justification ensuring approvals in line with delegation of authority.Identify cases to litigate and engage In-House Litigation Attorney on strategyAttend settlement conferences and mediation when necessaryConduct routine claim reviews with business leaders, adjusters, safety, finance, and leadershipConduct post review of all significant resolutions to identify strengths and areas for improvement in the claim management processInsurance Program ManagementLead insurance renewal strategy and analysis discussionsOversee development of renewal submissionsInnovation ProjectsWork with external partners, i.e., panel counsel; insurance consultant; vendors as well as internal partners to identify and evaluate process flows, tools etc. to enhance programUtilize Insurance Broker resources to provide 3rd party audits with development of action plans for improvement based on audit resultsUtilize TPA audit findings to develop process improvement strategies and action plansSupport business development team in modeling insurance and claims projections for bidding opportunities and participate in RFP efforts
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BostonSkillsProcess Design / Management and ReportingStrong Customer Service skills and ability to influence othersAbility to engage cross functionally in support of strategic business goalsEffective communication with multiple levels of the organization including executive leadership as well as with vendors / claimants as needed.Sound decision making skills having practical sense of escalation needsEffective leadership skills with ability to motivate team members / vendors / peersDetail oriented with solid ability to apply analytics to decision making and KPI developmentKnowledge and ExperienceExperience designing and leading claims management programsExperience in partnering with Legal, TPA and Insurers for effective claims litigation managementFinancial acumen in liaising on actuarial studies and accrual managementDemonstrated knowledge of best practices in claims managementExperience developing educational materials to communicate / educate program stakeholdersKnowledge of RMIS systemsProficiency in Microsoft Office Programs - Word, PowerPoint, Excel7+ years of Insurance and Claim ManagementEducationBachelor’s DegreeProfessional Certifications / Designations such as CIC, ARM, CRMP, CPCU preferred.Key AccountabilityClaims Process ManagementWork with location and TPA to ensure effective processes of preservation / collection of all pertinent documentation including videos, recordings, etc. for investigationsPartner with TPA to evaluate and develop strategies for prompt resolutionCollaborate with In-House Legal with respect to litigated claims and settlement activitySeek and maintain best practice claim management processes (e.g., prompt claimant contact, expression of empathy; resolution strategy development; prompt resolution)Interact routinely with internal and external customersOversee the development of monthly claims reports in partnership with TPA and or financial analyst. Present to various audiences including CEO.Meet monthly with TPA for program status, needs, trends, action plan updatesCollaborate extensively with stakeholders related to safety, risk mitigation, and claim reductionReview claim reports and determine defense/development and provide feedback to TPA to develop strategy for resolution taking accident/event severity; known facts and venueReview reserve needs with TPA for appropriateness, presenting changes to the Reserve Committee with justification ensuring approvals in line with delegation of authority.Identify cases to litigate and engage In-House Litigation Attorney on strategyAttend settlement conferences and mediation when necessaryConduct routine claim reviews with business leaders, adjusters, safety, finance, and leadershipConduct post review of all significant resolutions to identify strengths and areas for improvement in the claim management processInsurance Program ManagementLead insurance renewal strategy and analysis discussionsOversee development of renewal submissionsInnovation ProjectsWork with external partners, i.e., panel counsel; insurance consultant; vendors as well as internal partners to identify and evaluate process flows, tools etc. to enhance programUtilize Insurance Broker resources to provide 3rd party audits with development of action plans for improvement based on audit resultsUtilize TPA audit findings to develop process improvement strategies and action plansSupport business development team in modeling insurance and claims projections for bidding opportunities and participate in RFP efforts
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