Claims Examiner

We are seeking a
Personal Injury Claims Manager
to lead, strategize, and optimize the firm's Personal Injury (PI) claims operations across multiple teams. This role plays a critical part in driving case efficiency, ensuring compliance with U.S. PI standards, and enhancing overall client experience and claim outcomes.

The ideal candidate brings deep expertise in U.S. personal injury or insurance claims management, with a proven ability to balance strategic leadership (70%) and operational oversight (30%). The successful candidate will be responsible for setting the direction of the PI claims function while mentoring case managers, improving workflow processes, and ensuring seamless coordination with attorneys and medical/legal partners.

Key Responsibilities

Strategic Leadership

• Develop and implement strategies to improve case management efficiency, claim resolution rates, and client satisfaction.
• Design team structures and optimize case workflows for improved throughput and quality of settlements.
• Establish negotiation frameworks and oversee KPI tracking related to claim cycle time, settlements, and escalations.
• Partner with executive leadership to identify opportunities for operational excellence and business growth.

Operational Oversight

• Provide mentorship, performance feedback, and case review guidance to Case Managers and related Specialists.
• Conduct case audits to ensure accuracy, compliance, and adherence to firm and U.S. PI standards.
• Coordinate with attorneys, medical professionals, and other key stakeholders to ensure timely claim resolution and client satisfaction.
• Support cross-departmental collaboration to address bottlenecks and ensure process alignment.

Compliance and Quality Control

• Ensure strict adherence to California Bar, HIPAA, and insurance communication standards.
• Maintain process transparency and documentation integrity in all claims management activities.
• Oversee data protection and ensure compliance across all operational systems and processes.

Performance and Reporting

• Track key success metrics including case throughput, cycle time reduction, settlement value optimization, and compliance accuracy.
• Utilize tools and data reporting systems to monitor productivity and identify opportunities for improvement.
• Provide regular performance and progress reports to the CEO and senior leadership team.

Key Performance Indicators (KPIs)

• Case throughput and resolution rates
• Claim cycle time reduction
• Settlement value optimization
• Client satisfaction and feedback scores
• Reduction in escalations or compliance errors

Qualifications

• 7+ years of experience in U.S. personal injury or insurance claims management, with at least 3 years in a leadership or senior operational capacity.
• Strong background in case workflow optimization, claims negotiation, and compliance oversight.
• Proven experience leading high-performing teams within a law firm or legal support services environment.
• Proficient in Filevine, Lead Docket, and Google Workspace for case tracking and operations management.
• In-depth understanding of California Bar, HIPAA, and U.S. insurance communication standards.
• Excellent leadership, analytical, and communication skills with the ability to inspire, mentor, and drive accountability.
• Strategic thinker with the ability to balance operational detail and high-level decision-making.
• Culturally agile, collaborative, and comfortable managing cross-border teams in a fast-paced, performance-driven setting.