Remote Stop-Loss Claims Leadership Role
Tokio Marine HCC (TMHCC) brings 50 years of service to the specialty insurance industry, today offering over 100 products to commercial customers in 180 countries around the world. Organic growth and over 60 successful acquisitions have grown our 2022 Gross Written Premium (GWP) to $5 Billion. Our workforce has grown to 4,300 worldwide big, but not so big that you cannot make a difference. Our Good Company values, including integrity, empowerment, and commitment to customer service, and a culture of innovation, communication, and collaboration make TMHCC a great place to work.
TMHCC Stop Loss, a $2 Billion division within TMHCC, leads the way in providing medical stop loss insurance sold to employers. Medical Stop Loss provides an added layer of insurance protection to employers who choose to self-fund their health benefit plans. Self-funding can incur risks from catastrophic claims, and Medical Stop Loss insurance from Tokio Marine HCC is designed to protect employers from that risk.
This role is remote.
Position Summary :
Responsible for leading the strategic integration operational excellence, and business innovation for the claims organization. This role combines deep expertise in Stop-Loss claims with a visionary approach to technology adoption, process improvement, and change management. The position drives efficiency by leveraging advanced systems, automation, analytics, and emerging technologies to streamline operations, enhance customer experience, and optimize financial performance.
Key Responsibilities :
- Direct cross-functional team for Innovation technology initiatives impacting the stop loss claims organization
- Must have stop loss claims experience
- Oversee and continuously improve operational workflows, focusing on eliminating inefficiencies, reducing turnaround times, and enhancing accuracy.
- Develop short- and long-term strategic plans for stop loss claims operations, aligning with corporate growth, profitability, and innovation objectives.
- Ensure all operational practices meet or exceed industry and regulatory standards, proactively adjusting to changes in legal, compliance, and market conditions.
Innovation & Technology Integration & Advanced Analytics :
Partner with IT and business units to identify, evaluate, and implement technologies that optimize claims processing, data reporting, and decision-making.Lead the design and deployment of automation tools, data analytics platforms, and AI-driven solutions to improve stop loss claims accuracy, fraud detection, and trend forecasting.Oversee system development and enhancements for stop loss claims modules and contact management systems to improve user experience and operational scalability.Drive integration of data initiatives, real-time reporting capabilities, and advanced analytics to enable data-informed decision-making.Monitor and measure the success of process changes through performance metrics, user feedback, and ROI analysis.Oversee the automation of data collection, cleansing, and reporting processes to ensure data integrity and minimize manual effort.Establish predictive and prescriptive analytics initiatives to identify emerging risks, optimize reserves, and improve underwriting decision support.Ensure analytics insights are embedded into day-to-day decision-making across stop loss claims, underwriting, and customer service teams.Collaboration & Stakeholder Engagement :
Serve as a primary liaison between stop loss claims operations, innovation teams, IT, legal, actuarial, underwriting, marketing, and regional offices.Build and maintain strong relationships with third-party administrators, brokers, reinsurers, and technology vendors.Ensure positive system user experiences by incorporating stakeholder feedback into development cycles and system enhancements.Champion the organization's innovation agenda internally and externally, positioning the company as a leader in operational excellence.Talent Development & Leadership :
Lead, mentor, and develop high-performing teams across stop loss claims and innovation functions.Foster a culture that embraces change, innovation, and accountability.Provide ongoing training to ensure staff proficiency in new tools, processes, and compliance requirements.Education, Experience & Knowledge :
4 Year / Bachelors Degree Business Administration, a related field, or the equivalent education and / or experience.6 years of leadership experience10 Years relevant and progressive experience in stop loss claimsPossess and have ability to apply advanced knowledge of principles, practices, and proceduresExcellent written and verbal communications skills with an emphasis on confidentiality, tact, and diplomacySuperior organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneouslyKnowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company's business to proactively respond to changing business environmentAdvanced proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word)Occasional travel (up to 10% of time)Tokio Marine offers a competitive salary and benefits package, including :
Generous paid time off (PTO), 12 paid company holidays401(k) Retirement Plan with 6% company matchHealth and dental insurance, and vision plan availableCompany-provided long-term disability and life insuranceOpportunities for advancement in a successful and growing organizationFlexible work schedules and a great work / life balancePaid Parental LeaveVolunteer Time OffEnjoy casual dress and work in a modern, comfortable office with free parkingRemote work scheduleThe Tokio Marine HCC Group of Companies offers a successful, dynamic organization experiencing rapid growth and are seeking energetic and confident individuals to join our team of professionals. The Tokio Marine HCC Group of Companies is an equal-opportunity employer.
