Role Summary
The Head of Complex Claims will lead the strategic handling of complex claims, litigation, coverage disputes and watchlist matters, providing expert guidance on claims strategy, reserving, stakeholder engagement and resolution planning. The role is accountable for maintaining the Claims Authority Matrix, overseeing claims referral processes, conducting technical peer reviews and promoting best practice across the claims function.
Providing strategic and technical leadership for Rokstone's complex claims proposition, the Head of Complex Claims is responsible for overseeing the management of complex, large loss and high-profile claims across the portfolio. The role drives technical excellence in claims handling through the development and maintenance of robust claims governance, reserving discipline, quality assurance standards and authority frameworks, ensuring consistent and effective claims management across all lines of business.
Working in close partnership with the wider Claims team, the role will ensure effective alignment between technical claims management and operational delivery, supporting efficient claims reporting, regulatory compliance, data integrity and service excellence. The role will also collaborate closely with underwriting, actuarial, capacity providers and other key stakeholders to provide portfolio insights, identify emerging trends, support profitable business growth and continuously enhance Rokstone's claims proposition.
Role Accountabilities
- Responsibility for the technical excellence of Rokstone’s claims proposition and overseeing the work of the technical claims team.
-
Analysis of new complaints, notifications and complex claims to determine a case strategy and efficient claims management.
- Maintain file overviews to provide regular reporting to stakeholders.
- Work in partnership with the Claims Operations team to ensure smooth and timely claims reporting
-
Build and manage relationships with external experts across all classes of business. Assist in management of TPA relationships, particularly contract terms and authorities.
- Engage in regular meetings with capacity providers to provide updates on complex losses.
- Mentor and provide training to the technical claims team where required to enhance their knowledge.
- Collaborate with the Actuarial team and other internal stakeholders on reserving, claims lifecycle and trends.
- Participate in the development of the Atomx products, particularly Quantum.
-
Take ownership of the reserving philosophy, claims handling protocol and INBR guidelines.
- Create and maintain a watchlist for pertinent complex losses.
- Review and approve referrals from the technical claims team within set authority limits.
-
Positively promote and raise the profile of the Rokstone Brand.
- Collaborate and share ideas to continuously improve and evolve the claims proposition on new and existing lines of business.
-
Responsibility for ownership, maintenance and oversight of the Claims Authority Matrix
-
Responsibility for technical peer review, file audits and quality assurance.
-
Any additional duties as assigned.
Complex Definition:
- Lawsuit naming Rokstone Group Limited or associated entity/carrier.
-
Watchlist Claims.
-
Denials.
-
Wording and Coverage Reviews.
-
Any other matters deemed appropriate as they arise.
Role Requirements
- Minimum of 10 years' experience handling complex losses across multiple lines of business.
-
Proven ability to develop and maintain effective claims strategies, applying strong technical expertise.
-
Demonstrable experience in mentoring, coaching, and leading claims professionals, with a commitment to developing technical capability within a team.
-
Legal qualifications and/or experience as a Qualified Solicitor are preferred but not essential.
-
Dip CII qualified as a minimum; progress towards ACII or equivalent professional qualifications is advantageous.
Skills and Abilities
- Excellent communication and leadership skills.
-
Strong ability to build effective relationships internally and externally.
-
In depth knowledge of US litigation process.
-
Proficient with Microsoft Suite of applications..
Management Duties
We are an equal opportunity employer, and we are proud to share that 93% of our employees say they can be themselves at work. We aim to hire our industry's finest people because the best people drive the best outcomes. And we forever challenge the status quo because we know there are always ways to improve things. Because together, we're limitless.
We value applicants from all backgrounds and foster a culture of inclusivity. We understand the need for flexibility, so work in a hybrid model. Please let us know if you require any reasonable adjustments during the recruitment process.
