R and D Claim Process Leader

📁
Claims
💼
Ohio Farmers Insurance Co
📅
210000E9 Requisition #

R&D Claim Process and Analytics Leader Job Summary

Provides the overall leadership and strategy for the development and implementation of data solutions as a key component of the claims strategy. Sets the overall planning and developing of the claims data and analytics roadmap and best practices. Develops meaningful insights from understanding our system of records, data model and external data sources. Provides thought leadership in in the area of business analytics to influence data-driven and analytics-supported business strategies and insights. Leads the continuous improvement initiatives and projects in support of the strategic direction of the Claims department. Assists claims leadership team with long term planning and project prioritization. Responsible for developing, recommending, and successfully executing the Claims R&D business plan and project portfolio. Leads the Claims R&D staff who is responsible for Claims Communication, Change Management, Guidelines, Job Descriptions & Training. Responsible for completing industry research and managing projects that provide process improvement and operational consistency.

 

Essential Functions (primary functions and/or reasons the job exists in order of importance)

  • Strategy Direction and Execution - Provides the overall leadership and strategy for the development and implementation of data solutions as a key component of the claims strategy. Sets the overall planning and developing of the claims data and analytics roadmap and best practices. Leads the continuous improvement initiatives and projects in support of the strategic direction of the Claims department. Responsible for developing, recommending, and successfully executing the Claims R&D business plan and project portfolio. This includes compiling, analyzing, and reporting research findings, and completing assigned operational tasks. Also assists national leadership team with long term planning, updating/reporting on plan progress, and with prioritizing future initiatives that influence and align with Claim department vision, mission, and goals. Is a member of the claims leadership team and a recognized technical subject matter expert (SME) in Research and Development.

  • Project Management - Leads and/or oversees multiple projects and effectively selects and allocates project team resources in order to design, re-engineer, recommend, and implement solutions prioritized and approved by Claims Leadership. Defines the project scope, schedule, budget, and resource and project documentation needs. Anticipates, recognizes, and takes appropriate action steps to address the associated change management impact on all projects.

  • Data Analysis - Develops meaningful insights from understanding our system of records, data model and external data sources. Provides thought leadership in in the area of business analytics to influence data-driven and analytics-supported business strategies and insights. Gathers, organizes, and

  • analyzes performance data and results to identify and report performance, trends, and opportunities; makes recommendations regarding areas of improvement. Creates reports and communicates results with claims leadership, agents, and business partners. Performs other tasks such as monthly/quarterly reports, department presentations, document creation, etc. tasks such as monthly/quarterly reports, department presentations, document creation, etc.

  • Human Capital Management - Performs human capital management responsibilities including employee and/or project team selection performance management, coaching in technical and career development, employee-related issues, employee morale and work environment. Responsible for work quality and customer service. Manages priorities and workload distribution, removes barriers that impede progress. Completes all personnel, salary administration, and reporting duties. Performs operational responsibilities that drive team performance including planning, execution, process improvement and best-practice sharing.

  • Claims Communication, Change Management, Guidelines, Job Descriptions & Training - Responsible for the successful planning, development, maintenance, and delivery of the ongoing operational processes within Claims:

    • Communication

    • Change management

    • Claims guidelines

    • Job descriptions

    • Technical claims curriculum/training (including new hire, GDPs, interns)

  • Guidelines and Performance Standards - Manages overall responsibility for developing, maintaining, documenting, and communicating operational standards and changes to claims guidelines, job descriptions, and performance objectives for the Claims department.

  • Industry Research - Responsible for ensuring that internal and external research is conducted by Claims R&D staff and/or project team members in order to identify potential people, process, and technology efficiencies, opportunities, innovations, or best practices within the insurance industry. Participates in professional industry groups and stays abreast of industry changes, advancements, and jurisdictional issues to communicate, develop, and incorporate best practices into the claims business. Shares new information, best practices, and processes.

  • Communication - Maintains effective and ongoing communication with claims department leaders and staff, internal and external business partners, insureds, claimants, agents, attorneys, other insurance companies, project team members, claims leadership, and vendors.

  • Collaboration/Subject Matter Expert (SME) - Collaborates with internal/external business partners and large account customers, seeking and/or providing assistance or input when needed to support claims recovery strategies. Collaborates with peers and other departments to make decisions that are in the best interest of the company. Assists business partners with project methodology, business/process flows, business case development, etc.

  • Vendor Management - Identifies vendor options, assists process managers with development of appropriate selection criteria, and requests information or quotes in order to identify qualified vendor options, develops business cases, and makes recommendations that meet business requirements.

  • Leader Assistance - Assists leader with business planning, processes, guidelines, and budget; is accountable for department expenditures. Also assists leader with identification of risk and mitigation strategies related to projects.

  • Travels as needed in order to perform other essential functions.

 

Desired Qualifications/Experience/Certification/Education (in order of importance)

  • 7 or more years of project management or related industry experience, managing a variety of projects, and with varying degree of complexity.

  • 5 or more years of experience leading, coaching, and/or developing direct reports.

  • Experience using a claims management system e.g. Guidewire or diary management system to accurately document file activities.

  • Experience in customer service, negotiation and conflict resolution.

  • Excellent oral, written, and interpersonal skills, resulting in the ability to interact with all levels of management and employee population.

  • Excellent analytical, tracking, and monitoring skills. Experience collecting, analyzing, and interpreting information and data to recommend policies, procedures, and solutions that drive effectiveness and efficiency.

  • Experience with Microsoft Windows, Outlook, and Excel or transferable software packages.

  • Strong organization and facilitation skills.

  • Ability to deal with ambiguity and complexity.

  • Industry recognized designation, such as CPCU, SCLA, AIC, Project Management Professional (PMP), etc.

  • Ability to travel, including overnight business trips as needed.

  • Valid driver’s license and a driving record that conforms to company standards.

  • Bachelor’s Degree or commensurate experience.

 

Physical Requirements (specific to the role)

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

  • Ability to work effectively in an office environment for 40+ hours per week (including sitting, standing, and working on a computer for extended periods of time).

  • Ability to communicate effectively in a collaborative work environment utilizing various technologies such as: telephone, computer, web, voice, teleconferencing, e-mail, etc.

  • Ability to travel as required.

  • Ability to operate an automobile within the parameters of the driving policy.

 

This job description describes the general nature and level of work performed in this role. It is not intended to be an exhaustive list of all duties, skills, responsibilities, knowledge, etc. These may be subject to change and additional functions may be assigned as needed by management.

Applications for positions posted on Westfield Careers must be filed on-line through the Westfield Careers portal.  If you are a disabled person who requires a reasonable accommodation to complete an online application, please contact HR Assist by email at hrassist@westfieldgrp.com.


We are an equal opportunity employer/minority/female/disability/protected veteran.

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