Job Description
1. Support leadership in goal setting and performance delivery
- Assist the Claims Manager in establishing individual and team goals aligned to departmental KPIs.
- Drive execution against the team's objectives through prioritization, tracking, and course-correction as needed.
2. Supervise, coach, and develop claims staff monitor performance
- Provide day-to-day supervision, technical guidance, and structured training for Commercial Claims staff.
- Monitor work quality, cycle times, customer experience outcomes, and operational results identify performance gaps and implement improvement plans.
- Conduct ongoing portfolio/file analysis to identify loss drivers, leakage, and opportunities for cost containment while maintaining a high-quality service experience consistent with Sompo standards.
3. Claim assignment, file direction, negotiation, and litigation oversight
- Assign claims appropriately based on complexity, authority level, and workload.
- Direct file strategy and development, including investigation, evaluation, negotiations, and timely disposition.
- Provide oversight and direction on litigated matters, including strategy, settlement posture, and coordination with defense counsel.
4. Handle/guide complex commercial claims and ensure compliance
- Provide direction and guidance on high-exposure, complex, or sensitive commercial claims.
- Ensure adherence to corporate claims policies and procedures, statutory/regulatory requirements, and ethical standards.
- Escalate issues appropriately and ensure documentation supports claim decisions.
5. Coverage guidance and application
- Partner with claims staff to evaluate coverage issues and ensure accurate policy interpretation and application.
- Support reservation of rights/denial decisions in alignment with internal guidelines and applicable regulations (as required by authority and process).
6. Stakeholder management and communication
- Provide regular updates on work in progress, key risks, trends, and operational needs.
- Maintain strong working relationships with internal business partners and stakeholders (e.g., Underwriting, Actuarial, Finance, Legal, Risk Engineering, Client/Producer teams, TPA partners where applicable) to ensure alignment and continued support.
7. Monthly open file reviews and quality management
- Perform monthly open-file reviews to assess file quality, compliance, technical accuracy, and service standards.
- Identify training needs and implement targeted coaching/learning to improve outcomes and consistency.
8. Support hiring, selection, onboarding, and staff development
- Assist in selection activities (interviews, assessments, recommendations) and onboarding plans.
- Build staff capabilities through development plans, mentoring, knowledge-sharing, and career progression support.
9. Innovation, automation, and AI-enabled continuous improvement
- Identify and evaluate opportunities to streamline claims workflows and improve decision quality using automation, analytics, and AI-enabled tools.
- (e.g., triage/routing optimization, document ingestion and summarization, coverage/letter drafting support, diary/task automation, litigation and severity risk flagging, leakage detection, and customer communication enhancements).
- Promote responsible use of AI by ensuring appropriate controls for privacy, security, model governance, bias/fairness considerations, auditability, and regulatory compliance.
- Develop business cases for process improvements (expected benefits, cost/effort, risks, controls), define success metrics, and track impact (cycle time reduction, improved accuracy/consistency, customer satisfaction, indemnity/expense containment).
- Foster a continuous improvement culture by capturing staff feedback, standardizing best practices, and sharing lessons learned across the team.
