Dir, Risk Insurance and Claims

PDS Health•Irvine, CA

19h•$169,000 - $227,000

About The Position

Now is the time to join PDS Health. You will have opportunities to learn new skills from our team of experienced professionals. If you're ready to take your career to the next level and gain valuable experience, apply today! The Director of Risk, Insurance and Claims is responsible for leading the organization's insurance programs and claims management activities across all lines of coverage. This role oversees the design, placement, and ongoing management of the company's insurance portfolio, including coordination with brokers, carriers, and third-party administrators. The Director will also oversee claims management processes, ensuring timely resolution, appropriate reserving, and effective oversight of complex claims. The role includes oversight of a multi-line insurance program (24+ lines) and a captive insurance structure, requiring strong technical expertise and strategic judgment. Success in this role requires the ability to translate complex insurance and claims data into actionable insights for leadership, while ensuring operational effectiveness and cost discipline. This role plays a key leadership role in advancing the company's insurance strategy, claims analytics, and risk financing framework.

Requirements

Bachelor’s Degree in Arts/Sciences (BA/BS) from an accredited college or university.
10+ years of progressive experience in insurance, risk management, or claims
6+ years of leadership experience
Experience managing multi-line insurance programs in complex organizations
Experience overseeing claims management and third-party administrators
Experience working with insurance brokers and carriers on program design and renewals
Experience analyzing claims data and developing actionable insights and reporting

Nice To Haves

Chartered Property Casualty Underwriter (CPCU) or
Accredited Accounts Receivable Manager (ARM) or
Certified Risk Management Professional (RIMS-CRMP)
Experience in the healthcare or healthcare services industry.
Experience supporting or working with captive insurance programs.
Familiarity with Origami Risk or similar RMIS platforms.

Responsibilities

Lead the design, placement, and renewal of the organization’s insurance programs across all lines of coverage.
Serve as the primary interface with the organization’s insurance broker, carriers, and external partners.
Oversee management of the organization’s captive insurance program, including coordination with captive administrators and advisors.
Develop and implement insurance strategies aligned with organizational risk tolerance and business objectives.
Oversee claims management processes across all lines, ensuring timely reporting, resolution, and appropriate reserving.
Manage relationships with third-party administrators (TPAs), including oversight of claims handling performance and service delivery.
Oversee workers’ compensation claims management, including trends, escalation, and resolution strategies.
Identify trends, patterns, and key drivers within claims data to inform risk mitigation and operational improvements.
Develop and produce monthly claims and insurance metrics, including claims roll-forward, development trends, and key performance indicators.
Provide insights and reporting to executive leadership to support decision-making related to risk, claims, and insurance structure.
Partner with internal stakeholders to ensure appropriate insurance coverage for new and evolving business activities.
Support evaluation of new and emerging risk exposures, including potential new coverage areas.
Drive continuous improvement in claims and insurance processes, including use of systems such as Origami.
Ensure accuracy and completeness of insurance documentation, including policies, renewals, and program summaries.
Provide guidance on insurance requirements, coverage interpretation, and claims-related matters.
Ensures compliance with all policies and standards, as well as state, federal and other regulatory bodies.