Vice President Claims and Risk Financing - Claims and Insurance @ Health First

Job Requirements

POSITION SUMMARY

The Vice President, Claims and Risk Financing manages all medical, professional and general liability claims and structures the enterprise insurance program to finance and mitigate said risk, including a wholly owned captive for Health First and its subsidiaries. The Vice President, Claims and Risk Financing manages outside defense counsel, collaborates with underwriting leadership on claims advisories and coverage issues and advises risk managers, general counsel, C-suite executives and senior leadership on claims strategy and insurance coverage, and, in coordination with the Chief Legal Officer (CLO/CRO), advises the Board of Directors on the same matters.

PRIMARY ACCOUNTABILITES

• Provides leadership for the Company's claims management program, with accountability for operations, budget and fiscal oversight, risk parameters, regulatory compliance, reserving practices, litigation management, claims guidelines adherence, and settlement and reserve authority in accordance with Health First's Delegation of Authority Policy.
• Leads enterprise loss control, risk prevention, and risk identification strategies by leveraging data analytics and trend analysis to mitigate liability exposure, improve patient safety, strengthen high-reliability practices, and optimize organizational operations.
• Directs and administers the Company's insurance program, ensuring appropriate coverage, adherence to insurance guidelines, event reporting, policy structuring, renewals, and cost-effective risk financing strategies that reduce total insurance costs.
• Provides technical leadership and guidance to claims staff, risk managers, executive leadership, boards, and company management on significant claims, coverage issues, claims strategy, and insurance matters, coordinating with the CLO/CRO on Board-level discussions.
• Maintains technical oversight of medical, professional, and general liability claims, ensuring effective claim management, documentation, reserve adequacy, and compliance with claims handling standards and Delegation of Authority requirements.
• Directs annual insurance renewals in partnership with leadership, brokers, underwriters, and Finance, including actuarial reserve planning, policy layering, retentions, captive utilization, and coverage optimization.
• Establishes and monitors key performance indicators, reporting, and analytics for claims and insurance operations, driving data-informed decision-making, continuous improvement, cost reduction, and enhanced service delivery.
• Manages the wholly owned captive insurance company, including strategic utilization, cost-reduction initiatives, regulatory and board reporting, annual board meeting preparation, and oversight of captive performance.
• Oversees outside defense counsel and attorney defense panels, including selection, budget management, performance evaluation, and compliance with Health First's litigation management and claims handling standards.
• Collaborates with underwriting leadership, brokers, carriers, and other stakeholders to ensure effective communication, coordination, and resolution of claims advisories, coverage issues, and insurance program matters.
• Serves as an objective enterprise resource for risk-related matters that may impact Health First's strategic objectives, operating performance, financial results, and overall risk profile in coordination with the CLO/CRO.
• Establishes standards, metrics, and best practices across claims and insurance operations to achieve loss cost objectives, improve quality outcomes, enhance customer service, and strengthen program performance.

LEADERSHIP ACCOUNTABILITIES

• Define and communicate a clear, compelling vision for the team that effectively ties into the mission and vision of Health First and inspire the team to achieve that vision.
• Provide leadership, motivation, coaching, feedback and support to foster and strengthen growth and development of an effective, high performing team.
• Lead change through effective communication, explaining the connection and value to the organization, creating stronger buy-in and urgency, while understanding impact to the team to obtain commitment.
• Demonstrate openness to hearing diverse ideas and thoughts; create a sense of inclusivity; and encourage collaboration across teams to help break down silos to meet the team’s and organization’s goals.
• Recruit, select, grow, and retain highly engaged, high performing diverse and inclusive associates.
• Display strong strategic and financial acumen in areas of responsibility in alignment with the organization's strategic objectives.

Work Experience

MINIMUM QUALIFICATIONS

• Education: Bachelor’s degree in relevant field.
• Work Experience:
• Seven (7) years of progressive claims and risk management experience with an insurance carrier or large complex healthcare system.
• Demonstrated experience managing people, budgets, and vendor relationships.
• Experience handling one or more of the following service lines: general liability, professional/medical liability or management liability.
• Licensure: None
• Certification: None
• Skills/Knowledge/Abilities:
• Demonstrated expertise interpreting insurance policy language and analyzing complex coverage issues.
• Ability to independently evaluate claims and formulate sound, well-reasoned coverage recommendations.
• Exceptional analytical, organizational and critical thinking skills.
• Outstanding writing skills, with the ability to develop persuasive, technically sound coverage analysis and advocacy positions.
• Excellent verbal communication and presentation skills.
• Strong client relationship skills and a commitment to delivering exceptional service.

PREFERRED QUALIFICATIONS

• Education: Juris Doctor (JD), Master of Business Administration (MBA), or related degree.
• Certification: CPCU (Chartered Property Casualty Underwriter), ARM (Associate in Risk Management), or RPLU (Registered Professional Liability Underwriter).
• Skills/Knowledge/Abilities:
• Ability to lead, coordinate and motivate a team of people to reduce the organization's total cost of risk.
• Executive demeanor with the ability to interact effectively with internal and external stakeholders, including boards of directors and senior leadership.
• Ability to devise and implement organization wide risk management policies.
• Ability to identify emerging risks and threats and recommend strategies and measures to reduce overall risk to the enterprise.
• Strong proficiency in strategic planning and understanding all the details that are inputs into long term organization objectives.

PHYSICAL REQUIREMENTS

• Majority of time involves sitting or standing; occasional walking, bending, and stooping.
• Long periods of computer time or at workstation.
• Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
• May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks.
• Workspace may vary from open to confined.
• May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

Benefits

ABOUT HEALTH FIRST

At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.

Schedule : Full-Time

Shift Times : 8:00am - 5:00pm

Paygrade : PG-VP