Overview:
The Director of Medical/PIP provides strong business leadership and technical expertise to oversee Medical and Personal Injury Protection (PIP) claims operations. This role ensures the effective execution of initiatives, regulatory compliance, and strategic direction while maintaining operational excellence. You will work independently and collaboratively with senior leadership to deliver innovative claims handling, reporting, and expense management improvements. This position reports to the Vice President of Claims.
Key Responsibilities:
- Own severity, service, and expense management for the Personal Injury Protection (PIP) line of business.
- Enforce company guidelines and procedures, maintaining a working knowledge of NY, NJ, MA, CT, NH, and PA regulatory claim handling guidelines and statutory requirements.
- Provide strategic direction for business processes, metrics, and budgeting related to the PIP operation.
- Implement changes across business units to improve productivity and operational efficiency, collaborating with other directors to achieve shared goals.
- Utilize metrics and reporting expertise to implement, analyze, and present performance reports on a weekly, monthly, and quarterly basis.
- Analyze complex data to drive recommendations for improving severity and expense outcomes.
- Deliver innovative ideas to enhance the claims operation and improve customer service for agents and policyholders.
- Communicate company goals, promote a problem-solving culture, and provide clear leadership to staff at all levels.
- Ensure compliance with industry best practices, state regulatory guidelines, and company policies.
- Manage expenses by monitoring current spending and implementing process improvements to reduce costs.
- Investigate and apply appropriate coverage policies for accurate assessment of PIP claims.
- Collaborate with other departments and senior management to resolve escalated issues and deliver optimal efficiency.
- Prepare and present written and oral reports to executive leadership on significant claim exposures, coverage determinations, and reserve recommendations.
Qualifications:
- Bachelor’s degree from an accredited college or university, or equivalent claims management experience.
- 7-10 years of experience in claims management with a strong background in PIP, Med Pay, medical bill adjudication, and litigation.
- Strong technical expertise in claims handling, with a proven ability to manage large-loss exposures.
- Excellent written and verbal communication skills, with the ability to present and influence senior leadership.
- Insurance designations (AIC, AEI, CPCU) are a plus.
- Proficient in Excel, with the ability to develop charts, pivot tables, and reports (Tableau experience is a plus).
Preferred Skills:
- Experience collaborating with Special Investigations Units (SIU) for fraud detection, major case initiatives, and mitigation.
- Strong analytical skills, with the ability to interpret complex data and reports to drive decision-making.
- Ability to handle multiple projects and responsibilities concurrently, with a focus on delivering results.
About the Company:
The Plymouth Rock Company and its affiliated group of companies write and manage over $2.0 billion in personal and commercial auto and homeowner’s insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 2,000 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.
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