VP - Claims Adjudication

As the Vice President of Claims Adjudication, reporting to the Chief Claims Officer, your purpose will be to collaborate in the design and execution of Pie's claims strategy and programs. In this role, you will lead Pie's claims adjudication function, ensuring the delivery of optimal claim outcomes and exceptional customer experiences. You are responsible for strategically building and leading a claims adjudication organization that executes on the overall claims strategies. You will be fostering relationships at every level both internally with team members and other senior leaders, as well as externally, working to build relationships with key partners in the industry.

How You'll Do It

Claims Adjudication Leadership

• Lead and oversee Pie's claims adjudication function across all jurisdictions.
• Plan and direct all aspects of claims adjudication operations, overseeing daily and long-term activities.
• Responsible for implementing claims programs for workers' compensation.
• Serve as the lead claims adjudication authority, bringing expert claims experience to the Pie Executive Team.
• Direct the quarterly review and settlement of large loss and catastrophe claims.
• Develop and guide claims adjudication procedures and policies to enhance the processing, investigation, and settlement of claims.

Claims Strategy Collaboration

• Collaborate with the Chief Claims Officer in the design and execution of Pie's overall claims strategy.
• Contribute claims adjudication expertise and insights to inform enterprise-wide claims initiatives.
• Partner with Claims leadership on strategic planning and departmental objectives.
• Ensure claims adjudication operations align with and support broader Claims strategy.

Organizational Development & Scaling

• Determine claims adjudication team organizational structure, expectations, span of control, and role expectations and KPIs.
• Develop claims adjudication objectives and goals in support of Pie's OKRs.
• Develop, measure and coach to performance and productivity goals and measurements (KPIs) for claims adjudication team members.
• Build strong claim talent, expertise, and customer focused team members.
• Responsible for cultivating a diverse, equitable, and inclusive culture within the claims adjudication team.
• Lead and develop a team of Directors and Senior Managers, including setting and tracking goals, assigning and reviewing work, managing processes and staff activities, performance management, coaching and mentoring.

Financial & Performance Accountability

• Responsible for fiscal reporting and budgeting for the claims adjudication operation and ensuring all financial goals are met.
• Build and track budgets for headcount planning and operational expenses for claims adjudication.
• Monitor claims metrics and performance trends to ensure achievement of department and company objectives.
• Drive continuous improvement in loss ratios and claims outcomes through strategic initiatives.
• Ensure claims adjudication operations support profitable growth and underwriting objectives.

Innovation & Technology Strategy

• Collaborate with the Chief Claims Officer and the Claims Technology Team leaders on the claims technology roadmap and vision for automation.
• Champion the adoption of innovative technologies and processes that transform the claims adjudication experience.
• Partner with Product and Enterprise Tech to ensure claims technology investments align with adjudication needs.
• Lead digital transformation initiatives that enhance claims processing efficiency and customer satisfaction.

Cross-Functional Collaboration & Influence

• Member of the Claims leadership team and Pie Executive Team, participating in strategic planning and decision-making.
• Collaborate closely with other Claims functions, Underwriting, Actuarial, Reinsurance, Product, Finance, Legal, and other departments.
• Represent claims adjudication perspective in product development, pricing, and risk management decisions.
• Support Pie's business development and marketing goals by participating in external events as Pie's claims subject matter expert.
• Provide claims adjudication insights and expertise to inform company-wide strategic initiatives.

Compliance & Risk Management

• Ensure compliance with all regulatory requirements across multiple jurisdictions for claims adjudication.
• Partner with Claims Regulatory Compliance team on fraud investigation oversight.
• Manage relationships with regulatory bodies and ensure timely reporting and responses.
• Develop and maintain risk management protocols for claims adjudication operations.

The Right Stuff

Required Experience & Leadership

• 15+ years of experience with workers' compensation claims, field claims operations, and claims adjudication.
• 10+ years of people management experience with a track record of developing next-generation leaders.
• Experience building and managing claims adjudication teams of 15+, with demonstrated success in developing leaders who have advanced in their careers.
• Must have experience managing second-line managers (Directors and Senior Managers).
• Expert knowledge of managing disputed and litigated claims across multiple jurisdictions.
• Strong industry leadership track record with experience in senior leadership roles across the insurance industry.
• Data-driven leader with broad knowledge of workers' compensation claims and claims adjudication best practices.
• Expert proficiency in analytical skills and understanding of claims metrics that impact overall company objectives.
• Proven ability to contribute strategic insight to the business and collaborate on enterprise claims strategy.
• Ability to inspire and influence others, creating a motivating environment that helps people through change in a positive manner.
• Fosters open communications, continuous improvement, and innovation while maintaining stability.
• Possesses necessary determination and urgency to drive understanding and adoption of new systems, governance and transformation.
• Ability to fluidly and effortlessly navigate various scenarios, modeling core shared values to all stakeholders, being decisive, and showing true ownership mentality.
• Superior oral and written communication skills with ability to present to C-suite executives and external stakeholders.
• Proven ability to represent the organization externally as claims subject matter expert.
• Experience in crisis communication and managing high-stakes stakeholder relationships.

The use of AI in Application Review: To support a fair, efficient, and consistent hiring process, we use AI-powered tools to assist in the initial screening of applications. These tools help us identify qualifications and prior work experiences that align with the requirements of the role. We may also use AI assistant video tools during interviews to support note-taking and candidate evaluation. All AI-powered outputs are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process.