Vice President, Claims

Group 1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Company Overview:

Clear Spring Property and Casualty Group (CSPCG) is comprised of four insurance carriers (Clear Spring Property and Casualty Company, Clear Spring Casualty Insurance Company, Clear Spring American Insurance Company, and Clear Spring National Insurance Company), each rated A- (Excellent) by A.M. Best. CSPCG assists companies in protecting themselves from today’s challenges through technology and innovation. CSPCG provides worker’s compensation, general liability, and other coverages through strong agency relationships.

Why This Role Matters:

The Vice President of Claims will be primarily responsible for the technical, operational, and administrative claim functions, including reserving practices.

How You'll Contribute:

• Lead all aspects of claims management for the organization.
• Responsible for technical, operational and administrative claims functions including reserving practices.
• Select and manage performance of Third-Party Administrators, Managed Care and other claims vendors.
• Oversee transitions/implementations of new claims TPAs.
• Manage key department-wide function(s) such as training, talent development, and change management.
• Lead and direct the claims management process, driving execution of best practices and related initiatives to reduce the total costs of claims, while providing exceptional member service.
• Provide the highest levels of technical direction to the adjuster team on significant claims and complex coverage issues.
• Establish Key Performance Indicators (KPIs) for all areas of claims operations, design reports to capture same, review and analyze monthly data and direct corrective actions where required.
• Manage and report on the quality assurance processes to evaluate the TPAs and defense panels’ adherence to claims handling standards.
• Ensure case reserves are consistent with our guidelines and philosophy. Monitor actual reserves to confirm accuracy.
• Prepare reports for Executive Leadership Team and lead review and discussion of same.
• Directly oversee the TPAs’ activities on workers’ compensation, commercial auto, and general liability claims.
• Establish and extend authority levels on all referred claims.
• Select, train and manage staff where necessary.
• Provide technical support to internal business partners, including underwriting, finance, and actuarial.
• Oversee the performance of claim audits quarterly.
• Track and analyze ALAE to ensure effectiveness and efficiency.
• Ensure claims are adjusted in accordance with applicable State laws and regulations
• Oversee and analyze cost containment mechanisms (early reporting, directing injured employee to preferred provider, utilizing preferred pharmacy, etc.
• Pursue prompt and accurate closure of claims.
• Manage claims reporting responsibilities for state agencies and reinsurers.
• Represent the company on claims-related matters with external business partners.

What We're Looking For:

• 15 or more years of work experience in an insurance company claims department or TPA.
• Advanced skills in coverage and insurance policy analysis, litigation management principles, investigative and negotiation techniques.
• Strong organizational skills and detail oriented.
• Ability to work independently and handle multiple tasks simultaneously.
• Strong working knowledge of Workers’ Compensation, Auto Liability, General Liability, Professional Liability and Employer Liability claims.
• Excellent verbal and written communication skills.
• Excellent customer service and collaboration skills.
• Extensive knowledge of P&C regulations and applicable law
• Extensive knowledge of insurance contracts and adjusting techniques.
• Familiarity with medical terminology, legal procedures, and claim evaluation.
• Demonstrated leadership, coaching, influencing, and teamwork skills.
• Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint.
• Previous supervisory experience required.
• Strong vendor management skills.

Compensation:

Our compensation reflects the cost of labor across several U.S. geographic markets. The base pay for this position ranges from $180,000/year in our lowest geographic market up to $225,000/year in our highest geographic market.  Pay is based on a number of factors including market location and may vary depending on job-related knowledge, skills, and experience.

Benefits Highlights:  

Employees who meet benefit eligibility guidelines and work 30 hours or more weekly, have the ability to enroll in Group 1001’s benefits package. Employees (and their families) are eligible to participate in the Company’s comprehensive health, dental, and vision insurance plan options.  Employees are also eligible for Basic and Supplemental Life Insurance, Short and Long-Term Disability. All employees (regardless of hours worked) have immediate access to the Company’s Employee Assistance Program and wellness programs—no enrollment is required.  Employees may also participate in the Company’s 401K plan, with matching contributions by the Company.

Group 1001, and its affiliated companies, is strongly committed to providing a supportive work environment where employee differences are valued. Diversity is an essential ingredient in making Group 1001 a welcoming place to work and is fundamental in building a high-performance team. Diversity embodies all the differences that make us unique individuals.  All employees share the responsibility for maintaining a workplace culture of dignity, respect, understanding and appreciation of individual and group differences.