Director, Claims Work Comp and MI PIP

Frankenmuth Insurance Company

About The Position

Under limited supervision and with significant independent judgment, the Director supervises and directs the handling of workers’ compensation and Michigan PIP claims. The role provides claims oversight and management expertise for workers’ compensation claims, including litigated claims, and non-litigated PIP claims. It sets handling strategies for complex and high-exposure claims and ensures appropriate investigation, evaluation, reserving, medical management, negotiation, litigation strategy, and timely resolution. The Director oversees medical bill review, workflows, claim outcomes, compliance, and operational performance. The role also manages employees within a major organizational business unit, generally through subordinate leaders, communicating organizational priorities, developing plans, organizing resources, and leading staff performance and development. The position builds relationships with external and internal business partners and performs other duties as assigned.

Requirements

Six to ten years in a related role, or an equivalent combination of education and experience.
Ability to work legally in the United States; visa sponsorship or support is not available, including for a U.S. permanent residency (green card) process.
Ability to perform each essential duty satisfactorily; reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Nice To Haves

CPCU designation preferred.

Responsibilities

Oversee the management and resolution of all workers’ compensation claims, including non-litigated and litigated claims, and non-litigated PIP claims.
Establish claim-handling strategies and provide direction on complex, high-exposure, catastrophic, disputed, and litigated workers’ compensation claims.
Ensure appropriate investigation, evaluation, reserving, medical management, negotiation, litigation strategy, and timely claim resolution.
Recommend defense counsel and monitor and evaluate counsel’s performance, rates, and geographic coverage.
Oversee medical bill review for workers’ compensation and PIP, including quality, cost containment, vendor performance, and compliance.
Maintain effective workflows and promote consistent delivery of high-quality work.
Monitor claim outcomes, reserve adequacy, litigation results, medical costs, quality, productivity, and customer service.
Ensure compliance with applicable laws and regulations, fair claims handling practices, internal standards, and authority guidelines.
Identify trends and implement improvements to claim outcomes, processes, service, and operational performance.
Participate in budgeting, staffing, workload planning, and resource allocation.
Build effective relationships with defense counsel, vendors, agents, policyholders, and internal business partners.
Communicate vision, priorities, performance expectations, and organizational goals to employees.
Develop and recommend strategic and operational plans and organize resources to achieve business results.
Train, coach, develop, and lead staff.
Oversee performance management, including performance planning, appraisal, employee development, and corrective action.
May recommend and/or implement employment actions, including hiring or termination, corrective action, promotions or demotions, and salary changes.
Perform other duties as assigned.