director of claims

AIG Claims, Inc.

<div><p>At AIG, we are reimagining the way we help customers to manage risk. Join us as a <b>Complex Claims Liability Director, TPA Oversight</b> to play your part in that transformation. It&rsquo;s an opportunity to grow your skills and experience as a valued member of the team.</p><p></p><p><b>
Make your mark in Claims</b></p><p>
Our Claims teams are the proven problem solvers of choice for clients, delivering consistent technical excellence and showcasing our service differentiation to create an unparalleled global claims handling experience. Through a robust stakeholder feedback loop and supported by consistent processes and leadership, we take pride in delivering responsive, fair and professional service with empathy and efficiency.</p><p></p><p><b>
How you will create an impact</b></p><p>
As Complex Claims Director &ndash; TPA Oversight, you will analyze and process bodily injury and third-party property damage claims by investigating and gathering information to determine the exposure on the claim; ensure proactive claims handling aimed at the prompt and cost-effective resolution of claims through well-developed action plans. You will determine need for and direct independent adjusters to gather information to determine exposure on the claim and control their costs.</p><ul><li><p>
Identify and evaluate coverage issues; prepare comprehensive coverage letters with supervisory review and analysis; retain and provide direction to coverage counsel when necessary.</p></li><li><p>
Assess liability and resolve claim within established evaluation. Maintain diaries and complete tasks within required timeframes as set forth by department guidelines; ensure claim files are timely and properly documented with clear and concise analysis on coverage, damages, reserves, and liability including an action plan for resolution. Process and pay invoices within a timely manner.</p></li><li><p>
Coordinate vendor referrals for additional investigation and/or litigation management. Calculate and assign timely and appropriate reserves; monitor reserve accuracy throughout the life of the claim.</p></li><li><p>
Refer case as appropriate to supervisor and management. Respond to requests or directions in a professional and timely manner.</p></li><li><p>
Attend arbitrations, mediations, settlement conference and trials.</p></li><li><p>
Successfully complete required State licensing examinations and continuing education requirement.</p></li><li><p>
Communicate with all internal business partners including underwriters to make sure underwriting is aware of large losses and industry trends.</p></li><li><p>
Partner with TPA Governance and Relationship Management to help TPA&rsquo;s and Insureds comply with claim handling and reporting guidelines.</p></li><li><p>
Work with TPA Claims Financial to check the accuracy of TPA financials ensuring alignment with TTPO financials.</p></li></ul><p></p><p><b>
What you will need to succeed</b></p><ul><li><p>
7 plus years of General Liability/Auto claims experience.</p></li><li><p>
Experience with complex and high exposure General Liability Bodily Injury and Property Damage claims.</p></li><li><p>
Excellent communication skills (verbal/written) and strong negotiation skills.</p></li><li><p>
Advanced experience and capabilities in litigation claims management, including ADR and mediation processes, involving auto/GL exposures.</p></li><li><p>
Strong technical expertise interpreting insurance contracts.</p></li><li><p>
In depth knowledge of claim handling procedures, claims performance strategies, and claim best practices.</p></li><li><p>
Advanced analytical and problem solving skills.</p></li><li><p>
Should also have a demonstrated ability to initiate and champion change initiatives that leverage technology and improve skills in benchmarking.</p></li><li><p>
Creativity in resolving challenging business problems, as well as ability to achieve business goals and objectives is essential.</p></li></ul><p></p><p>
Ready to accelerate your career? We would love to hear from you.</p><p></p><p>
Compensation for this position includes base salary and eligibility for a bonus in accordance with the terms of the applicable incentive plan. In addition, we&rsquo;re proud to offer a range of competitive benefits, a summary of which can be viewed here: US Benefits.</p><p></p><p>
#LI-AIG #claimsprofessionals #InsuranceJobs #legalcareers #paralegaljobs #claimsexaminer #claimsadjuster #InsuranceCareers #insuranceTPA
</p><p></p><p>At AIG, we value in-person collaboration as a vital part of our culture, which is why we ask our team members to be primarily in the office. This approach helps us work together effectively and create a supportive, connected environment for our team and clients alike.</p><p></p><p><b>
Enjoy benefits that take care of what matters</b></p><p>
At AIG, our people are our greatest asset. We know how important it is to protect and invest in what&rsquo;s most important to you. That is why we created our Total Rewards Program, a comprehensive benefits package that extends beyond time spent at work to offer benefits focused on your health, wellbeing and financial security&mdash;as well as your professional development&mdash;to bring peace of mind to you and your family.</p><p></p><p><b>
Reimagining insurance to make a bigger difference to the world</b></p><p>
American International Group, Inc. (AIG) is a global leader in commercial and personal insurance solutions; we are one of the world&rsquo;s most far-reaching property casualty networks. It is an exciting time to join us &mdash; across our operations, we are thinking in new and innovative ways to deliver ever-better solutions to our customers. At AIG, you can go further to support individuals, businesses, and communities, helping them to manage risk, respond to times of uncertainty and discover new potential. We invest in our largest asset, our people, through continuous learning and development, in a culture that celebrates everyone for who they are and what they want to become.</p><p></p><p><b>
Welcome to a culture of </b><b>inclusion</b></p><p>
We&rsquo;re committed to creating a culture that truly respects and celebrates each other&rsquo;s talents, backgrounds, cultures, opinions and goals. We foster a culture of inclusion and belonging through learning, cultural awareness activities and Employee Resource Groups (ERGs). With global chapters, ERGs are a cornerstone for our culture of inclusion. The talent of our people is one of AIG&rsquo;s greatest assets, and we are honored that our drive for positive change has been recognized by numerous recent awards and accreditations.</p><p></p><p><i>
AIG provides equal opportunity to all qualified individuals regardless of race, color, religion, age, gender, gender expression, national origin, veteran status, disability or any other legally protected categories.</i></p><p></p><p>
AIG is committed to working with and providing reasonable accommodations to job applicants and employees with disabilities. If you believe you need a reasonable accommodation, please send an email to candidatecare@aig.com.
</p><p></p><div><div><div><div><div><div><div><p>Functional Area:</p></div></div></div></div></div></div></div>
CL - Claims<p></p>
AIG Claims, Inc.</div><p></p>

Complex Claims Liability Director, TPA Oversight

Chubb Insurance

<div><p>Chubb is seeking a Senior Claim Director to handle claims in the Employment Practices Liability group. The Senior Claim Director, under appropriate direction from the manager, investigates and settles employment claims promptly, equitably and within established best practices guidelines. This non-remote position is based in our Pittsburgh, PA office will report to the Assistant Vice President of EPL Claims.
</p><p><i>This is not your average Claims role.
</i></p><p>When you think of a job handling insurance claims, you may think about storm damage or auto accidents. Or maybe a large stack of paper?
</p><p>A career in Employment Practices Liability exposes you to emerging issues in the workplace that have been and remain at the center of national and global media. Issues such as the Me Too movement, Racial Injustice and Covid.
</p><p>In this paperless environment, you will use your analytical skills to resolve workplace claims.
</p><p>We will teach you about Employment Law, contracts and claims. You will use your influence skills and knowledge to partner with defense counsel and our insureds in resolving discrimination, harassment and other workplace related claims.
</p><p>The work is interesting. The environment is collaborative.
</p><p>Our Claims Professionals in Employment Practices Liability enjoy the work they do and working with their peers that come from a variety of backgrounds (including Law Enforcement, Human Resources, other disciplines in Claims and Legal, to name a few) and bring different perspectives into the team.
</p><p><b>Responsibilities after training include:
</b></p><ul><li>Contribute to a collaborative environment by raising new ideas and demonstrating teamwork, high motivation, positive behavior and effort to achieve goals and objectives.
</li><li>Complete accurate and timely coverage, liability and damage investigations and evaluations on complex Employment Practices Liability insurance policies.
</li><li>Establish, document and execute appropriate strategies to bring early and cost-effective resolution to assigned claims.
</li><li>Represent the company at meetings with management and business partners, as well as virtually at mediations.
</li><li>Effectively utilize technology systems and tools to track and manage caseload in most efficient and effective manner.
</li><li>Build and maintain productive relationships with internal and external customers, including clients, underwriters and agents.
</li><li>Consistently demonstrate sound claim handling practices by achieving compliance in areas including investigation, coverage, loss assessment, and case management.
</li><li>Assume part of training responsibilities for new claim examiners.
</li><li>Provide coaching and guidance to new claim examiners.
</li></ul><p><b>Qualifications:
</b></p><ul><li>BA/BS College Degree. JD is preferred, but not required.
</li><li>7+ years work experience, handling claims of a comparable complexity or working in a legal position.
</li><li>Prior EPL / Financial Lines work preferred.
</li><li>Excellent verbal and written communication skills.
</li><li>A personal commitment to superior performance that adds value to our company.
</li><li>Strong interpersonal skills with the ability to interact and build relationships with all levels of internal and external customers.
</li><li>An aptitude for evaluating, analyzing, and interpreting technical information.
</li><li>Sound decision making skills.
</li><li>Proven ability to work independently as well as part of a team.
</li><li>Must demonstrate a high level of initiative and leadership skills.
</li><li>Excellent time management, problem solving, and organizational skills are required.
</li><li>An ability to adapt to new ideas and situations.
</li><li>A willingness to use creative thinking to overcome obstacles and an ability to develop creative approaches to solving customer problems.
</li></ul><p><b>Additional Requirements:
</b></p><p>Training: Chubb managers, claim examiners and defense counsel provide a combination of classroom and on-the-job training to ensure our Claim Examiners are prepared to assume full claim handling responsibilities. The training will involve a wide range of knowledge and skill development, including:
</p><ul><li>Cultivating relationships with internal clients (e.g. underwriters)
</li><li>Developing the ability to analyze initial claim reports
</li><li>Developing an understanding of the legal system
</li><li>Understanding how to effectively investigate and document findings
</li><li>Understanding Chubb&rsquo;s products to appropriately determine coverage
</li><li>Learning to interpret and apply insurance contracts
</li><li>Learning how to negotiate settlements
</li><li>If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure.</li></ul></div>
<br><div><div>Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.<br>
</div><div></div><br>
<div>At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.</div></div>

Senior Claim Director

Uber

<div>Uber is looking for a pivotal leader to shape and optimize the future of our claims strategy with a specific focus on the <b>Investigation &amp; Liability </b>portfolio. We are seeking a visionary who can look at how insurance claims have traditionally been investigated and ask, &quot;How can we do this differently?&quot; by leveraging Uber's unique advantages as a connected platform and technology company.
<br>
<br>
<b>About the Role
</b><br>
<br>
As the <b>Senior Manager, Claims Management </b>, you will be a key leader on our claims team, reporting directly to the <b>Director, Claims Management </b>. You will lead the <b>Investigation &amp; Liability </b>portfolio as an individual contributor, guiding the strategy while collaborating with stakeholders across the claims organization to execute. We remove barriers to decision-making, encouraging a &quot;Go Get It&quot; spirit where you can leverage technology and AI tools to solve complex problems. This role is for a claims expert and leader who can go deep into <b>comparative negligence </b>and <b>investigative methodology </b>on automobile injury claims, identifying tools and solutions to ensure accurate liability evaluation, thorough fact-finding, and effective resolution by our carrier and TPA partners.
<br>
<br>
This role is targeted for Phoenix, AZ, or Chicago, IL, with relocation available. We operate on a hybrid working model of three days a week in the office. Uber provides a great in-office experience, including free snacks and meals, to support your work and collaboration.
<br>
<br>
<b>What You'll Do
</b><ul><li><b>Lead Portfolio Strategy &amp; Vision: </b><b>Guide the Investigation &amp; Liability domain to maximize impact in lowering severity. You will build, lead and execute the blueprint for how Uber leverages process, technology and partners to achieve optimal outcomes
</b></li></ul><ul><li><b>Optimize Decision-Making: </b>Identify when to make fast, easy liability decisions when fact patterns are clear and supported. You will ensure we don't let perfect information get in the way of actionable results, while knowing exactly when to &quot;go deep&quot; with EDR data, accident reconstruction experts, or field evidence.
</li><li><b>Leverage Data for Actionable Insights: </b><b>Define business requirements for new data, reporting, and AI-driven insights to ensure every investigation strategy drives meaningful action and severity management.
</b></li><li><b>Drive Tangible Severity Results: </b>You are responsible for driving real, measurable results in lowering severity as measured by set OKRs and KPIs. This includes building low-speed or low-severity workflows to set expectations early and defend against &quot;soft fraud&quot; medical build-up.
</li><li><b>Executive Presence &amp; Data Storytelling: </b>You will lead the discussion on liability outcomes and action plans at Quarterly Business Reviews (QBRs) with our partners. You will know exactly what data is needed to drive decisions and prove the impact of your strategies.
</li></ul><b>Basic Qualifications
</b><ul><li><b>Experience: </b>At least 7 years of professional experience in the insurance industry (carrier, broker, MGU, TPA, fleet, solutions partner, etc.) with a focus on auto or general liability claims.
</li><li><b>Leadership: </b>At least 3 years of leadership experience, demonstrating an ability to guide widespread strategies and process implementation across a claims portfolio.
</li></ul><b>Preferred Qualifications
</b><ul><li><b>Claims Visionary: </b>A seasoned veteran who can look at traditional property damage and bodily injury claims (including UM/UIM) and see opportunities to do it differently.
</li><li><b>A &quot;Go Get It&quot; Spirit: </b>A self-starter with a track record of driving impactful execution. You are comfortable guiding a portfolio as an individual contributor while influencing senior stakeholders across the organization to execute your vision.
</li><li><b>An iterative mindset: </b>You bring a willingness and ability to be creative in your approach to solving traditional claims problems, leveraging technology and AI to stay ahead of the curve.
</li><li><b>A powerful lens for data: </b>You have an expert understanding of what data is required to manage a portfolio and how to leverage it to drive and demonstrate impact with clear, measurable results.
</li><li><b>Nimble Mindset: </b>The ability to thrive in a fast-paced environment where you are encouraged to think bigger and move at &quot;Uber speed&quot;.<br>
</li></ul><br>
<br>
For Chicago, IL-based roles: The base salary range for this role is USD$162,000 per year - USD$180,000 per year. For Phoenix, AZ-based roles: The base salary range for this role is USD$144,000 per year - USD$160,000 per year. For all US locations, you will be eligible to participate in Uber's bonus program, and may be offered an equity award &amp; other types of comp. All full-time employees are eligible to participate in a 401(k) plan. You will also be eligible for various benefits. More details can be found at the following link https://jobs.uber.com/en/benefits.</div>

Senior Manager, Claims Management (Investigation & Liability)

Acrisure LLC

<div></div><div><div>Job Description</div><div></div><div>
About Acrisure</div><div></div><div>
A global fintech leader, Acrisure empowers millions of ambitious businesses and individuals with the right solutions to grow boldly forward. Bringing cutting-edge technology and top-tier human support together, we connect clients with customized solutions across a range of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services &ndash; and more.</div><div></div><div>
In the last twelve years, Acrisure has grown in revenue from $38 million to almost $5 billion and employs over 19,000 colleagues in more than 20 countries. Acrisure was built on entrepreneurial spirit. Prioritizing leadership, accountability, and collaboration, we equip our teams to work at the highest levels possible.</div><div></div><div>
Job Summary</div><div></div><div>
Acrisure is seeking a Regional Director of Workers Compensation Claims to join our growing team!</div><div></div><div>
The Director of Regional Claims is responsible for overseeing 6-7 full time direct reports in determining coverage, compensability, and benefits due. Ensures ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements. Identifies subrogation of claims, clear and concise action plans, reserving and settlements. Some travel may be required.</div><div></div><div>
Responsibilities</div><div>
(Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)</div><ul><li>
Review, assign and supervise all claim activity for designated claims to ensure compliance with company best practices, client specific handling instructions and in accordance with applicable laws.</li><li>
Responsible for oversight in assessing compensability, coverage, AWW/CR and timely payments.</li><li>
Reviews and approves settlement of claims within designated authority.</li><li>
Responsible for overseeing reserve establishment and/or oversight of reserves for designated claims within established reserve authority levels.</li><li>
Monitors necessary state filings within statutory limits.</li><li>
Oversees the litigation process; ensures timely and cost-effective claims resolution.</li><li>
Reviews vendor referrals utilized in investigation and/or litigation management.</li><li>
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.</li><li>
Monitors and approves claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.</li><li>
Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.</li><li>
Ensures claim files are properly documented and claims coding is correct.</li><li>
Refers cases as appropriate for further review.</li><li>
Leads team manager meetings and assigns accountability for follow-up items.</li><li>
Mentors and provide ongoing training and assist in the development of claim staff.</li><li>
Review and maintain supervisory diary on claim system.</li><li>
Oversees all claim activity for specified accounts.</li><li>
Compliance with Corporate Claim Handling Standards and special client handling instructions as established.</li><li>
Key part of the team with Team Manager/Lead to interview adjusters and provide feedback.</li><li>
Provides assistance and support to Team Manager/Lead with monthly review of adjusted workloads; notes trends and suggests adjustments when necessary.</li><li>
Participates in claim reviews both telephonic and in person as needed.</li><li>
Participates in onsite meetings with insureds.</li><li>
Collaborates with adjusters, team managers, insureds, and brokers on a regular basis.</li></ul><ul><li>
Actively and enthusiastically share experience and knowledge of creative resolution techniques to improve the claim results of others.</li><li>
Supports the organization and management.</li></ul><div></div><div>
Desired Skills/Abilities</div><ul><li>
In-depth knowledge of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.</li><li>
Excellent oral and written communication, including presentation skills</li><li>
PC literate, including Microsoft Office products</li><li>
Analytical and interpretive skills</li><li>
Strong organizational skills</li><li>
Excellent negotiation skills</li><li>
Good interpersonal skills</li><li>
Ability to work in a team environment</li><li>
Ability to meet or exceed Performance Competencies</li></ul><div></div><div>
Education and Experience Requirements</div><ul><li>
Bachelor&rsquo;s Degree preferred</li><li>
Workers&rsquo; Compensation licensing a plus</li><li>
Five to ten years of adjusting experience</li><li>
Three to Five years of prior supervisory experience</li><li>
Familiarity with state workers&rsquo; compensation laws and regulations</li><li>
Strong communication and prior training experience</li></ul><div></div><div>
#LI-hybrid</div><div>
#LI-remote</div><div></div><div>
Pay Details:</div><div></div>
The base compensation range for this position is $170,000 - $200,000. This range reflects Acrisure's good faith estimate at the time of this posting. Placement within the range will be based on a variety of factors, including but not limited to skills, experience, qualifications, location, and internal equity.<div></div><div>
Candidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership.</div><div></div><div><br>
Why Join Us:</div><div>
At Acrisure, we&rsquo;re building more than a business, we&rsquo;re building a community where people can grow, thrive, and make an impact. Our benefits are designed to support every dimension of your life, from your health and finances to your family and future.</div><div></div><div>
Making a lasting impact on the communities it serves, Acrisure has pledged more than $22 million through its partnerships with Corewell Health Helen DeVos Children's Hospital in Grand Rapids, Michigan, UPMC Children's Hospital in Pittsburgh, Pennsylvania and Blythedale Children's Hospital in Valhalla, New York.</div><div></div><div><br>
Employee Benefits</div><div>
We also offer our employees a comprehensive suite of benefits and perks, including:</div><ul><li><div>
Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.</div></li><li><div>
Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.</div></li><li><div>
Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.</div></li><li><div>
Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.</div></li><li><div>
&hellip; and so much more!</div></li></ul><div><i>
This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.</i></div><div></div><div><br>
Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Applicants may request reasonable accommodation by contacting <i>leaves@acrisure.com</i>.</div><div></div><div>
Final candidates will be required to complete post-offer verification processes related to the role and in accordance with applicable laws.</div><div></div><div><br>
California Residents: Learn more about our privacy practices for applicants by visiting the <div>Acrisure California Applicant Privacy Policy</div>.</div><div></div><div><br>
Recruitment Fraud: Please visit here to learn more about our <div>Recruitment Fraud Notice</div>.</div><div></div><div><br>
Welcome, your new opportunity awaits you.</div></div>

Regional Director Workers' Compensation Claims - Southeast

Speridian Technologies

<div><h2 class="jobSectionHeader"><b>Job Title:</b> Principal Product Manager Claims and Encounters</h2><h2 class="jobSectionHeader">
Location: Remote (Working hours are Monday-Friday PST)<br>
Division: Medical Enterprise System Modernization Division (MESMD), Behavioral Health Transformation Project (BHT)<br>
Department: California Department of Health Care Services (DHCS)</h2><h2 class="jobSectionHeader">
Must work on shore in the US. We cannot sponsor or transfer an H1B Visa for this role.
</h2><b>About the Behavioral Health Transformation (BHT) Initiative</b><br>
California&rsquo;s behavioral health system is undergoing one of the most significant transformations in its history. Driven by new legislation&mdash;including the Behavioral Health Services Act and related reforms&mdash;DHCS is working to modernize how behavioral health services are delivered, tracked, and improved across the state.<br>
The BHT initiative is a multi-year effort to re-architect the way DHCS partners with counties and providers to deliver care, measure outcomes, and produce transparency, and accountability. This work requires a new generation of digital tools, data infrastructure, and service delivery models. <b>At its core, BHT is about making real changes in the lives of Californians&mdash;ensuring every dollar spent can be tied to improved access, quality, and health outcomes.</b><br>
<br>
We are seeking a strong, multidisciplinary, Principal Product Manager to drive the modernization of our claims and encounter capabilities supporting Behavioral Health Transformation (BHT).<br>
While DHCS receives claims and encounter submissions today, the systems are fragmented and lack transparency for counties, providers, and managed care plans. We are building user-facing operational software that enables submitting entities to directly manage submission quality, reconciliation status, and reporting accuracy &mdash; and to be accountable for the integrity of their data.<br>
This role requires deep, hands-on experience owning Medicaid claims and encounter systems. The ideal candidate understands adjudication workflows, CMS reporting requirements, healthcare interoperability standards, and how operational systems drive accountability.<p><b><br>
Statement for Speridian Technology</b></p><p>
Speridian Technology is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Reasonable accommodations are available for qualified individuals with disabilities during the application process.</p><br>
This is a senior individual contributor role operating and owning outcomes at the intersection of policy, operations, data standards, compliance, and engineering.<br>
<br>
What You&rsquo;ll Do<ul><li>
Translate the strategic requirements for BHT operational systems into an executable roadmap aligned to statutory deadlines.</li><li>
Own roadmap prioritization, epics, and user stories and ensure adherence to all technical delivery standards.</li><li>
Work directly with operations and data policy teams to transform state and federal financial and accountability reporting obligations into clear, implementable product requirements.</li><li>
Own the modernization and user experience of external-facing claims and encounters management software enabling submission, validation, reconciliation, transparency, accountability and compliance.</li><li>
Design user workflows that improve data quality at the source and give counties, providers, managed care plans, and DHCS visibility into submission status, data quality, state and federal compliance.</li><li>
Coordinate and drive the development of enterprise business process maps, data models, and technical architecture with policy, data, and engineering partners.</li><li>
Ensure claims and encounter systems integrate seamlessly with Medical Enterprise Systems.</li><li>
Define measurable outcomes tied to compliance, timeliness, reconciliation accuracy, and operational performance</li></ul><br>
Required Experience<br>
Candidates must demonstrate:<ul><li>
10+ years of product management experience in healthcare technology</li><li>
Direct ownership of Medicaid or government healthcare claims and/or encounter systems</li><li>
Deep understanding of:</li><li>
Claims adjudication workflows</li><li>
Managed care encounter reporting</li><li>
CMS Medicaid reporting requirements</li><li>
CPT/HCPCS/ICD coding structures</li><li>
Substantial experience with healthcare data standards, including:</li><li>
USCDI</li><li>
HL7 / FHIR APIs</li><li>
Standard code sets and validation frameworks</li><li>
Experience translating regulatory and reporting requirements into system functionality</li><li>
Experience operating within California state reporting environments strongly preferred</li></ul>
Strongly Preferred<ul><li>
Experience modernizing or consolidating fragmented claims or encounter systems</li><li>
Experience building submission engines, validation services, or transaction gateways</li><li>
Familiarity with MITA and Medicaid Enterprise modernization</li><li>
Experience enabling user-facing operational tools that improve data quality and compliance</li><li>
Experience working in complex public-sector or managed care environments</li></ul><br>
What Success Looks Like<ul><li>
Submitting entities have clear visibility into claims and encounter status and data quality</li><li>
Validation and reconciliation workflows are transparent and standardized</li><li>
Data quality improves at the point of submission rather than through downstream correction</li><li>
Claims and encounter capabilities integrate cleanly with other DHCS operational systems</li><li>
Operational accountability across delivery systems measurably increases</li></ul><br>
Why This Role Matters<br>
Claims and encounter systems are foundational to Medi-Cal oversight, reporting, and payment integrity. Modernizing these capabilities enables transparency, improves data quality at the source, and strengthens accountability across California&rsquo;s behavioral health delivery system.<br>
<p>
</p><p>WKTkMt5Ew6</p></div>

Principal Product Manager, Claims and Encounters

<div><p>We are seeking a <b>Senior Claim Specialist </b>to join our <b>Westchester Property Claims Unit </b>.<br>
</p><p></p><p>Westchester, a division of Chubb, is one of the largest and most diverse excess and surplus lines commercial property and casualty insurance underwriters in the United States. Focused on the wholesale distribution channel, Westchester provides innovative specialty products for property, specialty casualty, environmental, professional risk, inland marine, product recall, small business, binding and programs.<br>
</p><p></p><p>This &ldquo;individual contributor&rdquo; desk adjuster position will service first-party commercial property claims throughout the United States, for our Digital, Programs and Middle Market business units by utilizing Independent Adjusters to determine cause of loss, coverage provided under the policy, and scope and repair value of damage. Adjustment will be done by promptly contacting clients; promptly and properly developing the claims file to provide accurate and timely investigation and loss analysis; maintaining an active diary; monitoring a diary claims system to achieve timely development of file and timely disposition of the claim; recognizing and pursuing recovery where possible; adhering to all statutory regulations and unfair claim practices act; establishing accurate and timely reserves; and effectively communicating with all internal and external customers.
<br>
<br>
Key functions of the role include proper evaluation of coverage and valuation of claim settlements, appropriate use of experts, ensuring the adequacy of reserves, providing high level of customer service, while delivering quality claim results.</p></div>
<br><div><p><b>Education: </b>College degree preferred or equivalent in education and experience.
<br>
<br>
<b>Competencies/Tech Skills: </b>We are seeking a candidate with 3-5 years of first-party commercial property claim handling experience. The ideal candidate will have a strong understanding of insurance contracts, industry trends, claim severity, and Chubb's systems, procedures, and philosophy.<br>
</p><p></p><p><b>Key qualifications include:
</b></p><ul><li>Proven ability to collaborate effectively across teams and build strong relationships with Claims and Underwriting partners.
</li><li>Excellent verbal and written communication skills, with the ability to engage and address diverse audiences.
</li><li>Service- and results-driven mindset, with strong analytical and decision-making abilities.
</li><li>Innovative thinker with ability to multitask, prioritize, and stay organized to meet objectives.
</li><li>Advanced organizational and time management skills, with the flexibility to adapt to a dynamic business environment.
</li>Strategic and innovative problem-solving skills to deliver creative solutions and achieve business objectives.<br>
<li>
</li></ul><p></p><p>This role requires a proactive approach to coordinating, deploying, and delivering exceptional claim service.<br>
</p><p></p><p>If you do not already have one, you will be required to obtain an applicable resident or designated home state adjuster's license within six months of employment.<br>
</p><p></p><p>The pay range for the role is $85,800 to $123,200. The specific offer will depend on an applicant&rsquo;s skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website . The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.</p></div>
<br><div><div>Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.<br>
</div><div></div><br>
<div>At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.</div></div>

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