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.
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
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
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
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
Performs other duties as assigned
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
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.
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)
Please complete this application and send with cover letter and resume to :
Rafaela Ortiz, Chief Operating Officer