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Coaction Global · 5 hours ago

AVP, Claims Audit

Morristown, NJ

Full-time

Hybrid

Director/Executive

$142K/yr - $175K/yr

15+ years exp

Coaction Global is a company that combines industry expertise to innovate in the insurance sector. They are seeking an Assistant Vice President, Quality Claims Audit to manage the internal claim audit team, develop quality audit programs, and provide strategic insights for improvement in claims operations.

Commercial InsuranceFinanceFinancial ServicesInsuranceInsurTechProperty Insurance

Comp. & Benefits

Responsibilities

Oversee and manage the internal team of claim auditors across multiple lines, including auto, workers' compensation, property, and legacy claims

Develop, implement, and enforce claims handling protocols and protocols to ensure high-quality service and outcomes across Claim Department and TPA programs

Cultivate and maintain strong relationships with underwriters and brokers to tailor claims-handling approaches to meet client needs

Ensure claims are handled in compliance with coverage evaluations, authority levels, staffing metrics, and litigation management; monitor prompt, quality investigations, timely reserving, and claim resolutions

Oversee Third-Party Administrator (TPA) audit and performance management, including best practice audits, service-level monitoring, and remediation plans

Oversee the tracking and evaluation of claim performance through onsite or virtual operational and best practice audits, coordination with Co/Action technical claim audit team to track claim performance metrics across internal teams and TPAs, identifying trends and implementing process improvements

Collaborate with business units to identify and mitigate risks associated with third-party vendors while exploring opportunities for improvement

Work with Underwriting and Program Managers (MGA’s, MGU’s) to secure renewals and new business opportunities for “unbundled business” through the use/approval of TPAs

Prepare and maintain documentation for TPAs, including contracts, policies, procedures, and reporting protocols

Recruit and develop quality staff, setting goals and objectives aligned with the corporate strategy

Lead the development and delivery of internal claims training programs, focusing on best practices, regulatory compliance, and complex claims handling across all lines of business

Partner with Claims leadership to identify training gaps and implement targeted education sessions for internal staff and supervisors

Conduct training sessions on third-party risk management programs and policies to ensure firm-wide compliance and understanding

Work closely with the Legal department to effectively manage contracts with third-party vendors

Prepare and deliver monthly and quarterly management reports and metrics to senior leadership

Monitor and control departmental expenses while balancing staff caseloads

Qualification

Claims ManagementTPA ManagementInsurance Industry KnowledgeContract ManagementLeadership SkillsProject ManagementTeam DevelopmentRelationship ManagementMS Office ProficiencyCommunication SkillsNegotiation SkillsProblem Solving