AVP, Program Claims Quality Assurance

Overview:

AmTrust Financial Services, a fast-growing commercial insurance company, has an immediate need for a Programs Claims AVP. This position requires previous management experience. This position will manage a team of program claim managers who are overseeing TPA’s handling Amtrust claims. The duties include the technical development of the program claim managers and their TPA oversight files which includes, coverage, liability investigation, development and evaluation of damages, settlement strategy and litigation management. These claims arise in various jurisdictions throughout the country and, as such, experience and adjusters’ license in multiple jurisdictions is required. This position will also have personnel administration responsibilities for the program claim managers under their supervision. Previous experience managing TPA’s is required. Ability to assist in TPA due diligence, implementation and program vetting. Need to be able review coverage forms and offer feedback.

• Oversees the escalated claims assigned to the unit including reserving, communication with the TPA and internal interested parties, documentation, litigation management, evaluation, negotiation and settlement.
• Ensures all escalated claims eligible or ineligible for payment conform to quality, production standards and specifications.
• Ensures claim processing is consistent with applicable policies, procedures and department guidelines.
• Ensures oversight claims are documented properly in system.
• Reviews issues adjusters are unable to resolve and prepares formal response to consumer complaints.
• Analyzes and approves reserve and settlement authority above Program Claim Manager authority and escalates to Vice President when necessary
• Completes regular quality audits of TPA’s and Program Claim Managers work, records results and counsels staff and TPA’s to bring work to or above standards.
• Prepares regular periodic reports and monitors system reports to ensure adherence to corporate and regulatory standards.
• Completes special projects as assigned.
• Assures that all customers receive quality service.
• Other tasks as assigned by Claims Director.
• Establishes and executes controls to assure that the quality of the work meets or exceeds standards.
• Reviews and analyzes processes, procedures and workflows to identify opportunities for process improvement and efficiency.
• May recruit, hire and recommend or initiate promotions, transfers and disciplinary action.
• Manages personnel administration including employee evaluations and salary administration.
• Participate in the specialized training and handling of complex claim matters and projects requiring advanced claim knowledge and experience.
• Manages the development and training of their team, including monitoring and relaying information to the staff regarding changes in coverage and laws

• Thorough understanding of laws, principles of coverage, liability and insurance industry in general.
• Analytical and human relations skills are critical.
• Leadership skills; ability to plan, organize, delegate and develop staff.
• Effective communication skills; ability to obtain and deliver information to others orally and in written form.
• Ability to carry out detailed written and verbal instructions.
• Ability to work with little supervision and direction.
• Sound command of the English language.
• Ability to operate business technology.
• College degree or 10 years equivalent experience and skills required.
• Valid adjuster’s license in appropriate jurisdictions or ability to obtain such.

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AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.