AVP-Claims Compliance
Location: St. Louis, MO
General Search & Recruitement
AVP-Claims Compliance
St. Louis, MO
Overview of Opportunity:
Broad responsibility for the overall management of the claim’s compliance function within the Insurance Compliance Department.
Reports directly to the Department head and is accountable for the development, direction and oversight of claims-related compliance activity for the company inclusive of regulatory change management, state and third party claim administrator (TPA) audits, claims reporting and data calls, claim penalty payments, claims- related research and consumer complaints for all applicable lines of business.
This upper level management position generally oversees, plans and supports the day-to-day activities performed by the claims compliance functional unit of the department comprised of non-exempt employees and/or exempt employees and/or lower level managers.
ESSENTIAL FUNCTIONS:
At Client Company, they live by the following five core values: Relationships, Integrity, Teamwork, Balance, and Stability. Our Core Values serve as the fundamental foundation of our corporate culture and drive our interactions, both internally and externally. An essential function of all Client Company positions is to fully embrace and represent these core values in our daily work life and relationships.
Responsible for proactively identifying, researching and assessing claims-related regulatory, compliance and business issues and offering appropriate solutions within area of responsibility.
Develops best practices and oversight of internal and external claims-related compliance with state regulatory requirements.
Establishes, maintains and communicates policy, procedures and guidance applicable to claims compliance activity.
Direct responsibility for leading, training, mentoring, evaluating, supervising and managing team members including but not limited to setting clear expectations, conducting/reviewing performance evaluations and providing coaching/feedback to team members or lower-level managers in support of corporate goals and team member growth/career development. Actively seeks opportunities for team development and/or training for direct reports. Acts as a mentor to others within the department and company.
Actively seeks opportunities for improvement of processes or functions within the department and responsible for pursuing strategies to facilitate change.
Responsible for complex matters requiring the use of sound judgement and initiative.
Participate in the implementation of operational strategies, policies, and workflow processes for assigned areas of responsibility.
Acts in a collaborative capacity with internal departments, external business partners, and regulatory personnel to investigate and resolve problems/issues promptly. Establish priorities and make workflow decisions, ensuring compliance with regulatory requirements as well as best practices.
.
ADDITIONAL RESPONSIBILITIES:
Special projects and assistance as may be required.
QUALIFICATIONS:
Prefer minimum 10 years’ experience in directly managing and/or handling P&C insurance claims.
Prefer minimum 3 years’ experience with State/Federal claims compliance with an insurance carrier or a third-party claims administrator.
Prefer minimum 5 years’ supervisory experience.
Must have strong organizational and analytical skills, as well as excellent written/oral communication skills.
11/2022
Broad responsibility for the overall management of the claim’s compliance function within the Insurance Compliance Department.
Reports directly to the Department head and is accountable for the development, direction and oversight of claims-related compliance activity for the company inclusive of regulatory change management, state and third party claim administrator (TPA) audits, claims reporting and data calls, claim penalty payments, claims- related research and consumer complaints for all applicable lines of business.
This upper level management position generally oversees, plans and supports the day-to-day activities performed by the claims compliance functional unit of the department comprised of non-exempt employees and/or exempt employees and/or lower level managers.
ESSENTIAL FUNCTIONS:
At Client Company, they live by the following five core values: Relationships, Integrity, Teamwork, Balance, and Stability. Our Core Values serve as the fundamental foundation of our corporate culture and drive our interactions, both internally and externally. An essential function of all Client Company positions is to fully embrace and represent these core values in our daily work life and relationships.
Responsible for proactively identifying, researching and assessing claims-related regulatory, compliance and business issues and offering appropriate solutions within area of responsibility.
Develops best practices and oversight of internal and external claims-related compliance with state regulatory requirements.
Establishes, maintains and communicates policy, procedures and guidance applicable to claims compliance activity.
Direct responsibility for leading, training, mentoring, evaluating, supervising and managing team members including but not limited to setting clear expectations, conducting/reviewing performance evaluations and providing coaching/feedback to team members or lower-level managers in support of corporate goals and team member growth/career development. Actively seeks opportunities for team development and/or training for direct reports. Acts as a mentor to others within the department and company.
Actively seeks opportunities for improvement of processes or functions within the department and responsible for pursuing strategies to facilitate change.
Responsible for complex matters requiring the use of sound judgement and initiative.
Participate in the implementation of operational strategies, policies, and workflow processes for assigned areas of responsibility.
Acts in a collaborative capacity with internal departments, external business partners, and regulatory personnel to investigate and resolve problems/issues promptly. Establish priorities and make workflow decisions, ensuring compliance with regulatory requirements as well as best practices.
.
ADDITIONAL RESPONSIBILITIES:
Special projects and assistance as may be required.
QUALIFICATIONS:
Prefer minimum 10 years’ experience in directly managing and/or handling P&C insurance claims.
Prefer minimum 3 years’ experience with State/Federal claims compliance with an insurance carrier or a third-party claims administrator.
Prefer minimum 5 years’ supervisory experience.
Must have strong organizational and analytical skills, as well as excellent written/oral communication skills.
11/2022
Must be proficient with Excel, Word and Microsoft Outlook applications. Bachelor’s Degree from accredited college or university required.
Master’s Degree from accredited college or university preferred.