AVP Claims - Professional Liability

AVP, Claims & Risk Education

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The AVP, Claims & Risk Education leads and oversees the claims department and function within the company and facilitates the delivery of risk education to insured members. This individual plays a critical role in ensuring the effective and efficient resolution of professional liability claims, including developing policies, procedures and controls, training and mentoring employees, using data and analytics to monitor progress, proactively identify trends and maintain supporting and enabling processes.  

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The ideal candidate has a strong background in claims leadership, portfolio management and professional liability insurance. This position requires a detail-oriented and analytical individual who can navigate the complexities of claims processing, maintain strong relationships with stakeholders, and drive continuous improvement within the department.

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Responsibilities

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Claims Handling Strategy and Policy Development:

• Working with senior leadership to develop claims handling philosophy.  
• Develop policies and deliver training to ensure department alignment.  
• Analyzing claims data to identify trends and areas for improvement.

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Leadership:

• A leader of the organization, directly overseeing and supporting claims department, ensuring they possess appropriate skill, expertise and capacity to effectively handle claims.  
• Setting departmental goals and performance standards and ensuring these align with the company's overall objectives.
• Continue to drive best practice performance
• Working closely with other departments, such as underwriting, operations, accounting to ensure a coordinated approach to claims management.
• Strive to recruit and retain strong performers and maintain adequate staffing levels to deliver claim services.

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Oversight and Controls:

• Develop and execute oversight controls, continually assessing and monitoring claims handling to ensure efficient and cost-effective resolution of claims.  
• Controls to include:
  • Financial authority: provides cascading internal authority for all roles within the organization to ensure appropriate oversight.
  • Reserving Guidelines: applicable to indemnity and expenses to ensure consistent reserving practices.  
  • Approved legal counsel panel: to guide appointment of counsel who have agreed to comply with the organizations litigation guidelines and have proven expertise with respect to accountants’ professional liability coverage.  
  • Litigation Guidelines: applicable to all files involving litigation to ensure alignment of expectations with respect to appointment, reporting, authority, fees and litigation budgets.  
  • Reporting:  reporting hurdles where internal examiners must provide leadership and or insurer with an update on file progression regardless of authority level involved.
  • Coverage Denial Management: any denial of coverage must be approved by leadership and insurer.
  • Quality reviews:  ensure there is a meaning quality review and audit process which identifies opportunities for improvement and develop action plans to address opportunity areas.

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Risk Education:

·       Collaborate with internal functional leaders to:

Develop insightful risk education material (seminars and or newsletters) aimed at risk avoidance and or mitigation.    

Proactively develop an annual workplan and intended target audience.  

·       Resource delivery of risk education seminars.  

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Compliance:

• Ensuring that all claims handling complies with relevant laws, regulations, and industry standards.
• Identifying potential areas of risk and developing strategies to mitigate these risks.

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Stakeholder and Customer Relations:

• Maintain effective communication and relationships with insurer markets, ensuring compliance with reporting and authority provisions.
• Managing relationships with policyholders, ensuring a high level of customer service.
• Handling escalated claims issues and disputes, working to resolve them in a fair and timely manner.

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Financial & Portfolio Management:

• Monitoring and managing expenses, ensuring efficient use of resources.
• Leverage joint capabilities, technology and scale to drive operational efficiencies.
• Working with leadership and data intelligence to devise reporting that informs capacity management, compliance with controls and proactively identifies financial trends.

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Continuous Improvement:

• Leading initiatives to improve claims processes and technologies, aiming for greater efficiency and effectiveness.
• Staying up to date with industry trends, regulations, and best practices, and incorporating these into the company's claims strategies.

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Qualifications

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·      A degree in a related field such as business administration, insurance, law, or finance.

·      An advanced degree (e.g., MBA, JD) or professional certifications can be advantageous.

·      Extensive experience in claims management, particularly within the professional liability insurance sector.

·      Proven experience in a leadership or management role, preferably within a claims department or similar environment.

·      Strong understanding of claims processes, insurance policies, and relevant legal and regulatory frameworks.

·      Ability to analyze complex data, identify trends, and make strategic decisions based on insights.

·      Excellent verbal and written communication skills, with the ability to interact effectively with internal and external stakeholders.

·      Strong negotiation skills, particularly in resolving claims disputes and handling large settlements.

·      Understanding of financial principles related to claims, including budgeting, loss ratios, and reserve management.

·      Commitment to providing excellent service to policyholders, brokers, and other stakeholders.

·      Strong attention to detail, ensuring accuracy in claims handling and reporting.

·      Ability to identify problems and implement effective solutions in a timely manner.

·      High ethical standards and integrity, particularly in managing confidential and sensitive information.

·      Specific knowledge of professional liability insurance, particularly in the context of professional services firms, is an asset.

·      Familiarity with legal aspects related to professional liability claims, such as malpractice laws and contract disputes.

·      Proficiency in using claims management software and other relevant technologies.

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