Director of Claims Management

Role

The Director of Claims Management is an exempt position, which reports directly to the Executive Director.

The Director of Claims Management is the lead claims administrator for Enduris.

Principal Functions

     Claims

  • 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 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 authority set by Executive Director and/or Board of Directors

  • Obtain authority from Executive Director, Board of Directors and/or reinsurer to settle claims above the authority limit

  • Coordinate and oversee communication regarding claim concerns with Administrative Assistant for Claims and Risk Management, 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 '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 selection of Defense Counsel

  • Schedule independent claims audit

     General Administration

  • Oversee 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, 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

Qualifications

  • BA in Business or related field

  • 5 or more years as a claim professional; prefer some supervisory or management experience

  • Ability to apply critical thinking and analysis of complex issues

  • Ability to effectively communicate complex issues and manage complex situations

  • Ability to travel via car and airplane for overnight business travel

  • Five years of experience in multi-line claims adjustment and coverage analysis

  • Extensive knowledge and experience in litigation management

  • Proficient computer skills: MS-Office, Excel and Origami (claims system)

  • Ability to work well with others including the management team, co-workers, members and service providers

Skills Required

  • Negotiating

  • Performing mathematical calculations

  • Analyzing data and using data to make decisions

  • Reviewing, organizing and writing reports

  • Using a personal computer and other various type of office equipment

  • Communication, interpersonal skills as applied to interaction with coworkers, supervisor, the general public, etc. sufficient to exchange or convey information and to receive work direction.

Physical Activities

  • Talking. Must frequently convey detailed information and interact with co­ workers and other professionals

  • Finger Dexterity. Uses primarily just the fingers to make small movements such as typing, picking up small objects, or pinching fingers together

  • Repetitive Motions: Movements frequently and regularly required using the wrists, hands, and/or fingers

  • Physical strength. Primarily sedentary work; sitting most of the time, although occasional walking, bending and lifting required. Exerts up to 5 lbs of force occasionally, and up to 40 lbs of force infrequently (almost all office related)

To Apply

Please complete this application and send with cover letter and resume to :

Rafaela Ortiz, Chief Operating Officer

rortiz@enduris.us