Job Title: Claims Compliance/Operations Manager

Location:  Sarasota, Florida

Job Description     

Summary: The Claim Compliance/Operations Manager will be responsible for compliance, technical reviews and writing/reviewing our claims best practices. This role will be responsible for file audits on differing levels of claims authority for handling TPA, internal reviews and MGA audit reviews. This individual will create reports based on areas of opportunity developed during reviews and assist in developing corrective action plans. The individual will prepare and distribute reports based on reviews and monitor compliance of the corrective action plans.

Includes the following. Other functions may be assigned as business conditions change.

• Responsible for developing and implementing a compliance scorecard. Prepares reports based upon review results.

• Develop and implement claim best practices and enhance claim process and procedures.

• Work with quality control and compliance management of partners and vendors to assure compliance with SLA’s Claim Best Practices, Regulatory and Statutory requirements and contract requirements.

• Communicates effectively and professionally with all departments and external customers and partners; must demonstrate strong oral and written communication skills.

• Responsible for performing the requisite audits, reviews and reinspections in order to assure compliance.

• Assists in the review and implementation of Corporate Best Practices and the review and revision of SLA’s.

• Must plan effectively and efficiently, organizes and handles multiple priorities while working independently. Maintains accurate and timely documentation for compliance while developing appropriate follow up measures.

• Responsible for conducting training classes and providing technical guidance and assisting Claim Management with technical matters both internally as well as TPA and appropriate Catastrophe IA vendors.

• Assist Property Claim Department in Catastrophic situations.

• Must work collaboratively with all departments and external customers, including TPA’s and other claim vendors.

• Must travel to other Universal locations, along with travel to TPA and/or claim vendor sites, external customers, claim sites and CAT sites.

Education and/or Experience:

• Bachelors Degree                                                                   

• 5-7 years of progressive experience in the Claim Management environment with an emphasis on compliance and developing claim best practice; experience in FL, TX and SC preferred.

• Must have specific property and casualty and auto claim experience at the operational level.

• Must demonstrate extensive knowledge of the claim process at all levels, as well as the ability to evaluate large and complex claims.

• Must be able to work in a collaborative atmosphere with TPA’s and other vendors.

• Must have prior field claim and management experience in an insurance company or large TPA environment.

• Must be computer literate; Microsoft Office, including Word, Excel, PowerPoint.

• Must have ability to analyze facts and make decisions, self starter, and excellent written and oral communication skills at all levels.

• Must have a valid driver’s license and a satisfactory Motor Vehicle Driving Record

• AIC and CPCU preferred

• FL 620 or Texas Adjuster license