Dir, Risk Insurance and Claims

Dir, Risk Insurance and Claims Irvine, CA Job Details Full-time $169,000 - $227,000 a year 1 day ago Benefits Health insurance Dental insurance 401(k) Tuition reimbursement Paid time off Vision insurance Qualifications Managerial strategic planning Strategic management Program design Program management 6 years Management Handling insurance claims Bachelor of Science Regulatory compliance Data reporting Improving operational efficiency CPCU Compliance management implementation Key Performance Indicators Analysis skills Continuous improvement Risk management Data interpretation Workers' compensation Associate in Risk Management Senior level Cross-functional collaboration

Leadership Bachelor of Arts Full Job Description Description:

Now is the time to join PDS Health. You will have opportunities to learn new skills from our team of experienced professionals. If you're ready to take your career to the next level and gain valuable experience, apply today!

Overview:

The Director of Risk, Insurance and Claims is responsible for leading the organization's insurance programs and claims management activities across all lines of coverage. This role oversees the design, placement, and ongoing management of the company's insurance portfolio, including coordination with brokers, carriers, and third-party administrators. The Director will also oversee claims management processes, ensuring timely resolution, appropriate reserving, and effective oversight of complex claims. The role includes oversight of a multi-line insurance program (24+ lines) and a captive insurance structure, requiring strong technical expertise and strategic judgment. Success in this role requires the ability to translate complex insurance and claims data into actionable insights for leadership, while ensuring operational effectiveness and cost discipline. This role plays a key leadership role in advancing the company's insurance strategy, claims analytics, and risk financing framework. Responsibilities Lead the design, placement, and renewal of the organization's insurance programs across all lines of coverage. Serve as the primary interface with the organization's insurance broker, carriers, and external partners. Oversee management of the organization's captive insurance program, including coordination with captive administrators and advisors. Develop and implement insurance strategies aligned with organizational risk tolerance and business objectives. Oversee claims management processes across all lines, ensuring timely reporting, resolution, and appropriate reserving. Manage relationships with third-party administrators (TPAs), including oversight of claims handling performance and service delivery. Oversee workers' compensation claims management, including trends, escalation, and resolution strategies. Identify trends, patterns, and key drivers within claims data to inform risk mitigation and operational improvements. Develop and produce monthly claims and insurance metrics, including claims roll-forward, development trends, and key performance indicators. Provide insights and reporting to executive leadership to support decision-making related to risk, claims, and insurance structure. Partner with internal stakeholders to ensure appropriate insurance coverage for new and evolving business activities. Support evaluation of new and emerging risk exposures, including potential new coverage areas. Drive continuous improvement in claims and insurance processes, including use of systems such as Origami. Ensure accuracy and completeness of insurance documentation, including policies, renewals, and program summaries. Provide guidance on insurance requirements, coverage interpretation, and claims-related matters. Ensures compliance with all policies and standards, as well as state, federal and other regulatory bodies. This is not intended to be a comprehensive list of the duties and responsibilities of the position and the duties and responsibilities may change. Qualifications Bachelor's Degree in Arts/Sciences (BA/BS) from an accredited college or university. 10+ years of progressive experience in insurance, risk management, or claims 6+ years of leadership experience Experience managing multi-line insurance programs in complex organizations Experience overseeing claims management and third-party administrators Experience working with insurance brokers and carriers on program design and renewals Experience analyzing claims data and developing actionable insights and reporting Preferred Chartered Property Casualty Underwriter (CPCU) or Accredited Accounts Receivable Manager (ARM) or Certified Risk Management Professional (RIMS-CRMP) Experience in the healthcare or healthcare services industry. Experience supporting or working with captive insurance programs. Familiarity with Origami Risk or similar RMIS platforms. Knowledge/Skills/Abilities Strategic insurance program management Claims analytics and risk reporting Broker and carrier relationship management Workers' compensation program oversight Risk financing and captive insurance structures Executive communication and cross-functional collaboration Strong analytical and negotiation skills Travel Approximately four times per year Benefits Medical, dental, and vision insurance Paid time off Tuition Reimbursement 401K Paid time to volunteer in your local community ‎ : PDS Health is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members.

Salary Information:

$169,000.00-$227,000.00 / Annually