Director of Claims Advocacy

The Plexus Groupe•Ela Township, IL

2d•Onsite

About The Position

The position provides claim advocacy leadership and support on behalf of clients in conjunction with the Plexus Client Service Platform to achieve desired outcomes. This involves interaction with clients, carrier claim adjusters, attorneys, and Plexus Team members to provide service needs to insureds and prospects. Specific expertise and service responsibilities required are outlined below.

Requirements

BA/BS or equivalent experience
Minimum 7-10 years of insurance experience required
Advanced knowledge of claims operating practices, litigation laws and regulations
Ability to communicate orally and in writing to others to explain complex issues, receives and interprets complex information, and responds in an appropriate, professional manner
Adept at utilizing carrier online claims systems and interpreting applicable claim data
Ability to work independently, as well as in co-ordination with other members of team
Ability to set priorities and manage workflow to ensure efficient, timely and accurate processing of transactions and other responsibilities
Working knowledge of property and casualty insurance coverages and usage
Working knowledge of claims adjustment process inside insurance companies
High level knowledge of computer and word processing programs such as Microsoft Office Programs (Word, Excel, Outlook), and agency management systems
Expected to maximize efficiencies using good organizational skills to prioritize and complete tasks in requested timeframes

Nice To Haves

Insurance designation such as CPCU, AIC, CIC, and/or ARM – preferred
Property and Casualty Agents license – preferred
Ability to manage direct reports - preferred

Responsibilities

Evaluate policy coverage, while serving as a consultant to mitigate exposure
Maintain system access to carrier and third-party administrator (TPA) risk management systems and analyze adjuster notes and claims data to keep clients apprised of claim developments
Provide technical support to Client Executive (CE) Teams in determining coverage applicability for property and casualty claims
Prepare claim analysis for individual, non-standard claim events for Clients and CE Teams
Be proactive and assertive while independently handling claim conflict resolution matters with carrier underwriters, claim adjusters and attorneys
Create and manage the formal claims review process for assigned Clients, either in person or telephonically, with prepared agendas and talking points
Process claims data, generate loss trending and analytics
Serve as a subject matter expert to the CE Teams with review of insurance and indemnification wordings in Client contracts and agreements
Lead claims adjustment process; establish timelines, set expectations for Clients and CE Teams, target desired outcomes and maintain open and continuous communication
Keeps senior management informed of significant development on complex claims
Engage in Client strategy, stewardship, pre-renewal, new and renewal meetings as requested by the CE Teams and/or Practice Leader
Participate in prospect-focused capabilities presentations as requested
Support CE Teams in M&A due diligence, for general coverage reviews and other assessment and analysis projects as required with strict attention to detail and uniformity
Identify and input relevant data as required in the Agency Management System (Epic) as well as setting up client electronic files
Builds and maintains effective relationships with Clients, carriers, co-workers, vendors and other business contacts
Develops, plans and implements strategic and tactical initiatives to meet business objectives
Participate in Client Executive Team meetings as requested
Any other duties as requested by management