Director, Claims

3 weeks ago

Toronto, Ontario, Canada DGA Careers Full time

Director, Claims

Company Profile

Our client, Healthcare Insurance Reciprocal of Canada (HIROC) is a trusted healthcare safety advisor, committed to offering a full spectrum of insurance, risk and claims management products and support.

HIROC knows healthcare as it's the largest not-for-profit healthcare liability insurer in the country, with over 700+ healthcare organizations part of the Reciprocal. Combined with sage counsel and risk management solutions, HIROC works with its partners to increase safety.

One common thread running through HIROC's culture is the feeling of being part of something unique: partnering to create the safest healthcare system – HIROC's vision.

Each employee has the opportunity to find their calling and help build a stronger organization designed to meet the needs of its Subscribers. As a Top 100 GTA Employer nine years running, HIROC employees are empowered to find solutions and create amazing experiences in service to its Subscribers.

By joining HIROC, you will be part of a team working to make a difference.

Summary

Reporting to the VP, Claims, the primary responsibility of the Director, Claims is to direct overall Claims Department operations while ensuring compliance and meeting business needs.

Key Responsibilities

Claims Function

  • Review initial documentation, apply legal/claims analysis and set/amend reserves
  • Complete coverage analysis, retain coverage counsel, prepare denial or reservation of rights letters as required
  • Instruct adjuster/lawyer on a continuing basis, settle/deny/defend decisions
  • Authorize expense and indemnity payments, mediations & pre-trials
  • Settlement authority to $500,00 indemnity, $500,000 expense
  • Sole Responsibility for HIV-related matters and all secure claims
  • Respond promptly and handle concerns/recommendations of subscribers
  • Participate in regular meetings with our Adjuster and Legal Managers to ensure timely and

quality work product of these vendors

  • Monitor for and respond to deficiencies

Direct Department

  • Coordinate team meetings and team building events
  • Lead and coordinate annual file reviews and preparation of Large Loss report for reinsurers
  • Direct overall departmental operations.
  • Lead a diverse team by providing direction, delivering mentoring/coaching, conducting
  • performance appraisals, and fostering personal development
  • Participate in development of staff objectives related to departmental plan.
  • Coordinate allocation of staff educational budget.
  • Acts for Vice President, Claims in their absence.

Organizational Planning and Implementation

  • Collaborative Leadership with HIROC's Directors and Other Leaders in the development of,
  • planning for and accomplishment of departmental and HIROC-wide strategies including
  • without limitation its strategic plan and resulting annual plans and budgets.
  • Direct the implementation of department and organizational strategic directives/objectives
  • including the management of timelines, socialization, change management, priority setting

and continuous improvements.

  • Participate in internal and external financial audits
  • Participate in reinsurance meetings and reinsurance audits
  • Participate in top risk quarterly dialogues
  • Participate in the Board Claims and Risk Management Committee.

Other Functions

  • Act as a resource to other HIROC staff.
  • Act as HIROC representative while delivering presentations, participating on external
  • committees, liaising with other organizations.
  • Payment approver for claims and organizational expenses
  • Chair Directors meetings and HMC per rotation schedule
  • Participate in weekly emerging trends huddle
  • Participation in annual partnership preparations and meetings
  • Participation in annual cyber workshops and risk residency programs
  • Maintain ongoing lens of subscriber needs.
  • Other duties as required

Knowledge, Skills & Abilities

  • Excellent communication skills with an ability to present compelling business cases on sensitive, complex issues
  • Strong analytical skills
  • Ability to problem solve and balance multiple priorities to ensure timelines are met
  • Enthusiastic and creative leader that drives for excellence

Education, Training & Experience

  • University Degree at the bachelor or master's level is preferable
  • 10 years of related work experience or an equivalent combination of education and experience
  • Completion of CIP, FCIP and/or CRM
  • Most importantly, you are an enthusiastic and creative thinker who is passionate about creating the safest healthcare system possible for Canadians

Compensation

A competitive compensation package, including base salary, bonus, DB pension, and benefits, will be provided.

DGA Careers is assisting with this appointment. To express interest in this opportunity and obtain more information on the role please forward your resume to Maurice Reichberg,

.

We thank all those who apply for the position, however, only those selected for an interview will be contacted. Thank you for your understanding.

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