Director, Claims Program Management – Occupational Risk

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Develop and implement the strategy, operational model, service standards, and annual objectives for the Occupational Risk claims program.

• Recruit, mentor, and maintain a high-achieving team of program managers and specialists.

• Oversee financial, operational, customer, quality, compliance, and talent outcomes within the designated portfolio.

• Create governance structures for third-party administrators (TPAs), managing general agents/managing general underwriters (MGAs/MGUs), independent adjusters, and other service providers.

• Direct operational evaluations, readiness for implementation, data organization, staffing assessments, control verification, disaster preparedness, and live governance.

• Execute annual or bi-annual audits of TPAs and MGAs/MGUs.

• Offer guidance on intricate, high-severity, coverage-sensitive, and litigated claims.

• Collaborate with Legal on counsel guidelines, litigation strategies, legal expenditures, panel performance, alternative dispute resolutions, and vendor results.

• Ensure adherence to state unfair claims practices standards, obligations of Texas Non-Subscribers and benefit plans, licensing requirements, privacy standards, market conduct, record retention, and internal policies.

• Uphold a risk-based audit program encompassing coverage, investigation, reserving, payments, communication, litigation management, subrogation, salvage, and compliance.

• Create dashboards and portfolio evaluations utilizing leading and lagging indicators.

• Enhance fraud referrals, subrogation, salvage, deductible, and aggregate tracking.

• Encourage prompt, transparent, empathetic, and brand-aligned communication with customers and brokers.

• Collaborate across various functions including Underwriting, Actuarial, Legal, Compliance, Finance, Reinsurance, Distribution, and Technology.

⛳️ Requirements

• Bachelor’s degree in insurance, risk management, business, finance, law, or a related discipline.

• Over 10 years of progressively responsible experience in commercial or specialty claims, including significant leadership roles.

• At least 5 years of experience in people leadership, program management, or delegated claims supervision within an insurance carrier, TPA, MGA/MGU, or similar entity.

• Considerable experience in Occupational Accident and Texas Non-Subscriber sectors; familiarity with Employer’s Liability, General Liability, Auto Liability, Physical Damage, or similar occupational risk products is highly preferred.

• Proven ability in managing complex claims, litigation, reserving, audits, regulatory responses, partner remediation, and executive reporting.

• Proficient in using claims platforms, business intelligence tools, and structured performance metrics to influence operational decisions.

• Relevant adjuster licenses, certifications, or continuing education as mandated by jurisdiction or assignment.

• Willingness to travel for partner due diligence, governance assessments, partner onboarding, business meetings, and employee activities.

• Advanced proficiency in Microsoft Office tools – Outlook, Excel, Word, and PowerPoint.

• Capable of thriving in a fast-paced environment and adaptable to change.

🏝️ Benefits

• Competitive compensation package.

• Generous 401K employer matching.

• Employee Stock Purchase plan with employer contribution.

• Ample Paid Time Off.

• Comprehensive health, dental, and vision benefits.

• Wellness programs focused on physical, mental, and financial health.

• Tuition reimbursement.

• Opportunities for industry-related certifications and professional training.

• A dynamic, ambitious, enjoyable, and stimulating work environment.

• Matching donation program.

• Opportunities for volunteer work.

• An employee-driven corporate philanthropy program.