AVP, Claims Audit

Coaction Specialty Insurance Group•Morristown, NJ

11d•Hybrid

About The Position

At Coaction, we’re a unique mix of leaders, achievers, thinkers, and team players with a high-performance mindset and a diverse skillset. We bring our industry expertise together to continually push the boundaries of what insurance can be for our clients. At Coaction, we’re a unique mix of leaders, high achievers, thinkers, and team players with a high-performance mindset and diverse skill set. We bring our industry expertise together to continually push the boundaries of what insurance can be for our clients. We are seeking an Assistant Vice President, Quality Claims Audit to join our Claims Team in either our Morristown, New Jersey, or New York City location. The Quality Audit Claims Assistant Vice President will be responsible for the day-to-day management of the internal claim audit, compliance and training team assisting in all aspects of the claim operation. The AVP of Quality Claims Audit is responsible to develop and oversee Coaction’s quality audit program, protocols and guidelines and this role will also support the development of our claims department by providing strategic insight and identifying areas of improvement throughout the business while conducting training and support on complex claims issues and compliance with regulatory requirements.

Requirements

15 years of experience in Claim Management.
5-7 years of TPA management experience.
Bachelor’s degree preferred
Strong claims and claims operational background.
Strong understanding of the insurance industry/market
A record of providing outstanding claim service and customer service experience
Excellent verbal and written communication skills with strong influencing communication skills
Experience in conflict resolution and strong negotiation skills
Results oriented, and ability to think strategically.
Excellent organizational skills and flexibility managing and tracking projects.
Enthusiastic, reliable, and collaborative leader.
Strong focus on problem solving and demonstrated commitment to teamwork/team development
Experience leading and influencing others through change
Demonstrates leadership skills to manage and drive solutions
Relationship/Partnership/Account management background – a plus
Proficiency with MS Office software, Excel and PowerPoint
Strong verbal and written communication skills

Nice To Haves

Familiarity with contract management and legal aspects of vendor relationships is a plus.

Responsibilities

Oversee and manage the internal team of claim auditors across multiple lines, including auto, workers' compensation, property, and legacy claims.
Develop, implement, and enforce claims handling protocols and protocols to ensure high-quality service and outcomes across Claim Department and TPA programs.
Cultivate and maintain strong relationships with underwriters and brokers to tailor claims-handling approaches to meet client needs.
Ensure claims are handled in compliance with coverage evaluations, authority levels, staffing metrics, and litigation management; monitor prompt, quality investigations, timely reserving, and claim resolutions.
Oversee Third-Party Administrator (TPA) audit and performance management, including best practice audits, service-level monitoring, and remediation plans.
Oversee the tracking and evaluation of claim performance through onsite or virtual operational and best practice audits, coordination with Co/Action technical claim audit team to track claim performance metrics across internal teams and TPAs, identifying trends and implementing process improvements.
Collaborate with business units to identify and mitigate risks associated with third-party vendors while exploring opportunities for improvement.
Work with Underwriting and Program Managers (MGA’s, MGU’s) to secure renewals and new business opportunities for “unbundled business” through the use/approval of TPAs.
Prepare and maintain documentation for TPAs, including contracts, policies, procedures, and reporting protocols.
Recruit and develop quality staff, setting goals and objectives aligned with the corporate strategy.
Lead the development and delivery of internal claims training programs, focusing on best practices, regulatory compliance, and complex claims handling across all lines of business.
Partner with Claims leadership to identify training gaps and implement targeted education sessions for internal staff and supervisors.
Conduct training sessions on third-party risk management programs and policies to ensure firm-wide compliance and understanding.
Work closely with the Legal department to effectively manage contracts with third-party vendors.
Prepare and deliver monthly and quarterly management reports and metrics to senior leadership.
Monitor and control departmental expenses while balancing staff caseloads.