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Key Responsibilities:

• Expertise Development: Maintain an advanced working knowledge of claims procedures, policies, system applications, and company life and annuity product features.
• Team Leadership: Drive the execution of team objectives, service delivery, and expectations by planning, organizing, and directing team members.
• Strategic Planning: Participate in strategic planning to develop operational plans that maximize departmental efficiency, productivity, and performance.
• Talent Development: Develop an internal talent pipeline by setting team and individual goals, coaching for performance, and fostering individual growth and development.
• Cross-functional Collaboration: Partner with stakeholders across the organization to drive large-scale initiatives and champion successful change implementation to create value.
• Support and Coordination: Provide ad hoc support for escalations and highly complex claims, and coordinate with leadership, sales, legal, compliance, reinsurance, underwriting, and actuarial teams to ensure contractual and company practices are maintained.
• Mentorship and Training: Mentor and support the technical training of examiners and participate in cross-organizational claim education.
• Professional Growth: Commit to ongoing professional development, including participating in industry conferences and maintaining industry relationships.

Preferred Qualifications:

• 6+ years of industry experience as a Claims Examiner or Underwriter, preferably in Life, Annuity, Disability, Long Term Care or Health insurance
• 3+ years of management experience, with a demonstrated ability to direct others, including developing, training, and executing performance goals.
• A comprehensive understanding of claims appeals, denials, medical terminology, and contract language.
• Exceptional leadership, team management, and interpersonal communication skills.
• Bachelor’s degree preferred, but applicants of various backgrounds are encouraged to apply
• Preferred background includes insurance industry and business process designations such as ALMI, FLMI, ALHC, FLHC, and CLU
• Proficiency with life insurance industry core systems, including claims, enterprise content management, and customer relationship management, as well as collaboration platforms

Job Description:

The Head of Claim Services will oversee a wide range of claims operations across life, preneed, and health product lines, including initiation, analysis, and auditing. This senior leader will lead fraud prevention and streamlining processes while enforcing clear claims guidelines, predicting claim volumes, and ensuring top-notch quality standards. They will work closely with Actuarial staff, manage the claims review committee activities, and handle audits. Lastly, they will guide vendor selections and address policy owner complaints effectively.

Required Qualifications:

• 8+ progressive years of experience in supervisory/managerial positions in claims service and management
• Broad view and understanding of claims administration beyond single-provider (claims administration technology, TPAs, etc.)
• Strong analytical skills and experience with generating reports and dashboards using claims data
• Knowledge of Electronic Data Interchange (EDI) for claims processing and system performance monitoring
• Experience leading large organizations and managing significant claims budgets
• Bachelor’s of Business Administration or equivalent experience

Preferred Qualifications:

• Experience in selecting and managing vendors for clearinghouses, payments, cost containment, networks, and claim processing
• Claims experience across multiple product lines including life insurance, preneed, Medicare Supplemental, dental insurance, and pet insurance (experience in all product lines is not required)
• Experience with special investigations and fraud prevention programs in the insurance industry
• The ability to participate in risk management meetings and analyze claim trends
• Understanding of relevant insurance regulations and compliance requirements