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Claims Director (Client Opening) in Grand Rapids, MI at Rehmann, LLC

Date Posted: 6/5/2018

Job Snapshot

Job Description

Experience of the candidate will include:

  • Leadership and operations
  • Technology and systems
  • Extensive complex litigation strategy
  • Sales and marketing
  • Presentation
  • Analytics
Essential Functions:

• Directs the development, implementation and on-going maintenance of claims handling systems, standard work, policies and procedures to confirm compliance to best practices, claims management manual/service standards, state regulations, and client service requirements
• Directs claims activities including overall review of claims for processing and adjudication, including reserve setting and claim/event evaluation, early resolution, primary liaison to defense attorneys and ensures compliance with litigation guidelines.
• Leads in conjunction with the VP of RM the RACA Committee. Lead for all Claims related committees (internal and external for clients)
• Review and report on claims measures assessing the effectiveness of MPIE’s claims processing functions. This includes productivity as well as financial indicators (financial indicator review will be under the direction of the CFO). Oversees activities for departmental alignment with expected targets.
• Oversee/conduct internal audits to assess MPIE's overall effectiveness in meeting client expectations and claims management outcomes. Monitor compliance to best practices, claims management manual/service standards, state regulations, and client service requirements.
• In conjunction with the CFO and Director of UW ensures a smooth system for reinsurance reporting and serves as a lead expert on MPIE reinsurance treaty and facultative approaches.
• Leads for all claims related external audits and reinsurers for claims reporting
• Leads in support of client services/account management in relation to claims.
• Carries a limited caseload of high reserve/complex cases.
• Serves as a subject matter expert on the claims information system and recommends changes for improvements
• Assists with the representing the claims department and function with prospects as part of the sales process
• Presentation ability-delivery and content development
• Directs and oversees all claims functions to ensure high level of customer service
• Develop, direct and maintain working relationships with all MPIE departments to assure prompt communications regarding claims activities.
• Participates as requested in representing MPIE in partner company projects/relationships related to claims.
• Travels as required.

Supervisory Responsibilities:

• Interviews, hires and establishes performance development plans; conducts staff performance discussions.
• Provides support, guidance, leadership and motivation to promote maximum performance.

Minimum Skills Requirement:

• Strong technical claims knowledge. Experience and demonstrated success in claims adjudication functions, including negotiation skills.
• Leadership/management/motivational skills.
• Analytical and interpretive skills
• Ability to successfully manage people and their varying skill levels.
• Excellent writing and speaking skills. Ability to deliver clear guidelines to all levels of management, including the MPIE board of directors.
• Demonstrated knowledge and understanding of Microsoft products and claims information systems, imaging process and financial systems in relation to claims.

Qualifications:

• J.D. Degree, or equivalent work experience in a healthcare claims operation
• CPCU, CLM, ARM, and/or AIC certifications preferred.
• 5 years of Professional Liability experience or the equivalent combination of education and experience required.
• Prior experience in a leadership or management role preferred, including ability to evaluate and determine project priorities, and work in a team environment.
• Ability to work independently with minimal direction and supervision. Exercise independent judgment in solving complex problems.
• Effective presentation skills, including public speaking.
• Own or lease an automobile. Proof of valid Michigan Driver’s license and registration.

Note:
Credit and security clearance confirmed via a background credit check is required for this position.

This description portrays in general terms the type and levels of work preformed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.

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