Claims Executive / Snr Executive

Job Description

1.  Support leadership in goal setting and performance delivery

• Assist the Claims Manager in establishing individual and team goals aligned to departmental KPIs.
• Drive execution against the team’s objectives through prioritization, tracking, and course-correction as needed.

2.  Supervise, coach, and develop claims staff; monitor performance

• Provide day-to-day supervision, technical guidance, and structured training for Commercial Claims staff.
• Monitor work quality, cycle times, customer experience outcomes, and operational results; identify performance gaps and implement improvement plans.

• Conduct ongoing portfolio/file analysis to identify loss drivers, leakage, and opportunities for cost containment while maintaining a high-quality service experience consistent with Sompo standards.

3.  Claim assignment, file direction, negotiation, and litigation oversight

• Assign claims appropriately based on complexity, authority level, and workload.
• Direct file strategy and development, including investigation, evaluation, negotiations, and timely disposition.
• Provide oversight and direction on litigated matters, including strategy, settlement posture, and coordination with defense counsel.

4.   Handle/guide complex commercial claims and ensure compliance

• Provide direction and guidance on high-exposure, complex, or sensitive commercial claims.
• Ensure adherence to corporate claims policies and procedures, statutory/regulatory requirements, and ethical standards.
• Escalate issues appropriately and ensure documentation supports claim decisions.

5.  Coverage guidance and application

• Partner with claims staff to evaluate coverage issues and ensure accurate policy interpretation and application.
• Support reservation of rights/denial decisions in alignment with internal guidelines and applicable regulations (as required by authority and process).

6.   Stakeholder management and communication

• Provide regular updates on work in progress, key risks, trends, and operational needs.
• Maintain strong working relationships with internal business partners and stakeholders (e.g., Underwriting, Actuarial, Finance, Legal, Risk Engineering, Client/Producer teams, TPA partners where applicable) to ensure alignment and continued support.

7.  Monthly open file reviews and quality management

• Perform monthly open-file reviews to assess file quality, compliance, technical accuracy, and service standards.
• Identify training needs and implement targeted coaching/learning to improve outcomes and consistency.

8.  Support hiring, selection, onboarding, and staff development

• Assist in selection activities (interviews, assessments, recommendations) and onboarding plans.
• Build staff capabilities through development plans, mentoring, knowledge-sharing, and career progression support.

9. Innovation, automation, and AI-enabled continuous improvement

• Identify and evaluate opportunities to streamline claims workflows and improve decision quality using automation, analytics, and AI-enabled tools.
• (e.g., triage/routing optimization, document ingestion and summarization, coverage/letter drafting support, diary/task automation, litigation and severity risk flagging, leakage detection, and customer communication enhancements).

• Promote responsible use of AI by ensuring appropriate controls for privacy, security, model governance, bias/fairness considerations, auditability, and regulatory compliance.
• Develop business cases for process improvements (expected benefits, cost/effort, risks, controls), define success metrics, and track impact (cycle time reduction, improved accuracy/consistency, customer satisfaction, indemnity/expense containment).

• Foster a continuous improvement culture by capturing staff feedback, standardizing best practices, and sharing lessons learned across the team.