Pharmacists Mutual Insurance Group has an opening for Vice President of Claims. This role is a senior executive responsible for leading the Company's claims strategy, operations, and performance. This role oversees all claims processes – including intake, investigation, adjudication, settlement, litigation management, and compliance to ensure accuracy, efficiency, financial discipline, and a consistent positive customer experience. The Vice President of Claims is also responsible for engaging directly with agents and key accounts to reinforce trust, transparency, and the organization's commitment to being a leading provider of specialty healthcare insurance solutions.
As a key member of the leadership team, the Vice President of Claims sets claims policies, establishes performance standards, and drives strategic initiatives that improve cycle time, cost management, and quality outcomes. They partner closely with other departments to ensure claims practices align with corporate goals, regulatory requirements, and profitability targets.
Essential Functions
Essential functions may include, but are not limited to the following:
- Assist the Division President with the overall strategic plan and goals for the business unit.
- Direct daily operations for all claims units.
- Develop and execute the claims strategy in alignment with organizational goals.
- Oversee claims budgets, financial performance, reserving accuracy, and cost-containment initiatives.
- Lead modernization efforts including automation, digital tools, analytics, and process redesign.
- Ensure timely, fair, and accurate claims handling with strong quality-control standards.
- Establish and monitor KPIs for items like cycle time, severity, productivity, customer satisfaction, and compliance.
- Act as a subject matter expert both internally and externally by being knowledgeable on industry and claims specific trends.
- Lead, coach, and develop claims managers, supervisors, and adjusters.
- Build a high-performing claims organization with strong technical expertise and superior service.
- Ensure compliance with federal and state insurance regulations and internal policies.
- Oversee complex or high-exposure claims, litigation strategy, and relationships with outside counsel.
- Ensure the maintenance and implementation of acceptable fraud-detection protocols and ethical claims practices.
- Partner with Underwriting to provide trend insights, loss analysis, product change suggestions, and other feedback.
- Collaborate with Actuarial and Finance on reserving, forecasting, and loss-ratio management.
- Engage with IT on claims technology, data analytics, and workflow improvements.
- Ensure the implementation of claims process, protocols, and workflows.
- Understand the corporate reinsurance structure including treaty language to ensure claims are ceded accurately and timely.
Knowledge, Skills and Abilities
- Deep knowledge of principles and practices of property & casualty claims and overall knowledge of insurance operations.
- Ability to analyze complex claim situations and manage complex claims to appropriate resolution.
- Skilled in negotiation strategies to achieve claim resolutions in a timely and accurate manner.
- Knowledge of advanced reinsurance, including the ability to interpret and apply reinsurance contract language.
- Ability to develop departmental budgets, manage expenses and adequately control resources to ensure successful operations within established budget, productivity and efficiency standards.
- Knowledgeable in systems capabilities, data and metrics/reports to analyze trends and improve organizational performance.
- Ability to develop and consistently meet departmental standards and metrics.
- Ability to perform under pressure and handle multiple concurrent priorities.
- Ability to set priorities, meet deadlines and manage diverse projects simultaneously.
- Skilled in strategic planning and the ability to develop team-level goals that align with corporate strategy.
- Excellent people and coaching skills, with an ability to motivate and lead a team.
- Possess personal qualities of integrity, credibility, and commitment to corporate mission.
- Strong executive presence to be able to present analysis and recommendations in a clear and compelling manner to both technical and non-technical audiences, including executive management, and the Board of Directors.
- Ability to use initiative and apply innovative thinking while effectively managing objectives and goals.
- Ability to work independently to make critical decisions and analyze complex issues.
- Ability to interpret and apply laws, rules and regulations in consultation with Legal Counsel.
- Exceptional oral and written presentation skills.
- Utilizes sensitive information discreetly and objectively.
