Head of Claims

Arthur is excited to be working in partnership with a fast growing and dynamic company at the forefront of innovation, leveraging cutting edge technology and a deep understanding of the healthcare sector.
My client works with insurers, re-insurers, large employers and affinity organisations worldwide. As the global leader in their field, they’re seeking a highly experienced and dynamic individual to join as Head of Claims.
The successful individual will play a critical role in initial reserving and ongoing review of Claims. You will also be responsible for monitoring large complex claims. As a key leader, you will provide technical expertise and influence the broader insurance strategy. As Head of Claims you will work closely with the actuarial, product and underwriting teams while taking on the exciting challenge of building a market leading claims function.
Your Role:

• Lead the claims resolution strategy and oversee all aspects of the claims process, including assessment, handling, adjustment, settlement, investigations, litigation, and recovery
• Provide input, support, and subject matter expertise to Claims Operations for the purpose of developing and implementing process/technology enhancements to improve efficiency, and reduce claims leakage
• Monitoring and measuring claim’s service levels and large loss claims
• Handle all Loss Reporting, including preparation of Large Loss report for re-insurers.
• Develop and report loss ratios and performance metrics for each reinsurance partner on an ongoing basis
• Investigate, analyse and propose solutions to complex Reserving and/or Monitoring issues, communicating results effectively both internally and externally
• Analyse claims trends and industry data to ensure high-impact operating results and fair outcomes
• Act as subject matter expert on claims supporting the Sales and Pricing teams
• Build and maintain productive business relationships with key external partners and clients

Your Skills, Experience and Qualifications:

• Proven experience in the Health/Medical insurance sector ideally working in an environment of low frequency but high severity claims
• Extensive understanding of insurance coverage interpretation, loss reserving, and client relationship management
• Strong knowledge of the claims life cycle and management of Claims
• Experience in process improvement and cost management
• Advanced ability to present complex factual, medical, and legal concepts in thorough but concise manner.
• Strong commercial awareness, and the ability to lead and deliver business critical projects.
• Ability to act as a thought leader and adapt claims priorities, decisions and road map based on the broader company strategy
• Exceptional communication skills, with an ability to build rapport and with an emphasis on real-time interaction, both written and verbal
• Proficiency in using data to extract insight using a variety of forward-facing tools to set up efficient, repeatable processes will be seen as a plus: e.g. R, Python, SQL, Power BI, Tableau, Alteryx

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