VP, Claims Adjudication

This is a fully remote position, open to applicants in United States.

📋 Description

• Lead and manage Pie's claims adjudication operations across all jurisdictions.

• Strategically plan and oversee daily and long-term claims adjudication activities.

• Execute workers' compensation claims programs effectively.

• Act as the primary authority on claims adjudication and provide guidance to the Pie Executive Team.

• Direct the quarterly assessment and resolution of significant loss and catastrophe claims.

• Create and enhance procedures and policies for claims adjudication.

• Work in conjunction with the Chief Claims Officer to shape overall claims strategy.

• Contribute to enterprise-wide claims initiatives and departmental goals.

• Establish the organizational framework, expectations, span of control, role specifications, and KPIs.

• Develop, assess, and mentor performance and productivity objectives.

• Foster claims talent and promote a diverse, equitable, and inclusive team environment.

• Guide and nurture Directors and Senior Managers through goal-setting, performance management, coaching, and mentorship.

• Oversee fiscal reporting, budgeting, workforce planning, and operational expenditures.

• Track claims metrics and performance trends closely.

• Propel ongoing enhancements in loss ratios and claims results.

• Ensure that claims adjudication operations align with profitable growth and underwriting goals.

• Collaborate on the roadmap for claims technology and the vision for automation.

• Advocate for innovative technologies and processes.

• Partner with Product and Enterprise Tech on investments in claims technology.

• Lead initiatives for digital transformation.

• Engage in strategic planning and decision-making within the Claims and Pie Executive Team.

• Cooperate with Claims, Underwriting, Actuarial, Reinsurance, Product, Finance, Legal, and other departments.

• Represent claims adjudication in product development, pricing, and risk management discussions.

• Serve as an external claims subject matter expert for Pie.

• Ensure compliance with regulations across various jurisdictions.

• Supervise fraud investigation activities in collaboration with Claims Regulatory Compliance.

• Manage regulatory relationships and reporting responsibilities.

• Develop and sustain risk management protocols for claims adjudication.

⛳️ Requirements

• Over 15 years of experience in workers' compensation claims, field claims operations, and claims adjudication.

• More than 10 years of experience in people management, demonstrating a successful history of developing future leaders.

• Experience in building and overseeing claims adjudication teams with 15 or more members.

• Experience in managing second-line managers such as Directors and Senior Managers.

• Expert knowledge in handling disputed and litigated claims across multiple jurisdictions.

• A strong record of leadership within the industry, with experience in senior roles across the insurance sector.

• Comprehensive understanding of workers' compensation claims and best practices in claims adjudication.

• Expert analytical skills with a solid grasp of claims metrics.

• Proven ability to provide strategic insights for enterprise claims strategy.

• Exceptional oral and written communication skills, capable of presenting to C-suite executives and external stakeholders.

• Proven capability to represent the organization externally as a claims subject matter expert.

• Experience in crisis communication and managing stakeholder relationships in high-stakes situations.

• Must reside and work within the United States (excluding territories).

• Access to reliable, high-speed internet is required.

🏝️ Benefits

• Competitive cash compensation.

• Comprehensive health insurance plans.

• Generous paid time off (PTO).

• Future-focused 401k matching program.

• Generous parental and caregiver leave.

• Discretionary bonuses may be awarded annually to eligible team members.