Claims Manager

CLAIMS MANAGER


REPORTS TO: DIRECTOR OF RISK MANAGEMENT
FULL-TIME/ SALARIED/ EXEMPT

Position Summary

The Claims Manager is responsible for leading the claims operations of the GSBA Risk Management Fund (RMF) and the GSBA Workers' Compensation Fund (WCF). This position provides strategic oversight of the investigation, evaluation, negotiation, and resolution of property, casualty, liability, and workers' compensation claims in collaboration with the Third-Party Administrator (TPA).

The Claims Manager ensures claims are administered promptly, fairly, and in compliance with applicable laws, regulations, Fund policies, and industry best practices. This role provides leadership and oversight to claims adjusters, TPAs, legal counsel, and other service providers to ensure exceptional claims handling, consistent service delivery, and positive member outcomes.

This position is responsible for monitoring claim reserves, settlement authority, litigation management, claims analytics, and overall claims performance to safeguard the financial integrity and long-term sustainability of the Funds. The Claims Manager also leads claims reporting, member support, and claims administration functions while partnering with RMS leadership to identify trends, mitigate risk, and support organizational objectives.

This role is jointly accountable with Risk Management Services (RMS) leadership for the financial performance, claims quality, and long-term sustainability of a portfolio serving Georgia K-12 public school districts and Regional Educational Service Agencies (RESAs). The position operates under the direction of the Director of Risk Management Services.

Primary Duties and Responsibilities

Functional Area/Category

ORGANIZATIONAL LEADERSHIP & CULTURE

• Champion and model GSBA's mission in support of public education.
• Foster a culture of excellence through exceptional customer service, collaboration, and organizational commitment.
• Maintain strong relationships with RMF and WCF members, Boards of Trustees, third-party administrators, legal counsel, medical providers, and other claims partners.
• Execute strategic directives established by executive leadership.

LEADERSHIP

• Partner with RMS leadership to enhance claims management strategies, improve claims outcomes, and strengthen operational effectiveness.
• Identify opportunities to improve claims handling procedures, workflows, and service delivery.
• Ensure adherence to claims handling guidelines, regulatory requirements, and industry best practices.
• Identify emerging claims trends and proactively communicate recommendations to the Director and Assistant Director of Risk Management Services.
• Collaborate with underwriting, safety and loss control, finance, legal counsel, and member advocates to improve overall risk management outcomes.
• Contribute to strategic initiatives, special projects, and new program development.

CLAIMS ADMINISTRATION & PROGRAM MANAGEMENT

• Partner with the Third-Party Administrator (TPA) to investigate, evaluate, negotiate, and resolve property, casualty, liability, and workers' compensation claims in accordance with Fund policies and applicable regulations.
• Review and approve claim reserves or provide reserve recommendations consistent with organizational policies and actuarial expectations.
• Assist the TPA claims adjusters in resolving complex, high-exposure, and litigated claims while maintaining exceptional customer service and professional file management.
• Authorize claim payments within established authority levels and recommend settlements.
• Review claims investigations conducted by adjusters and third-party administrators to ensure appropriate coverage determinations and settlement recommendations.
• Verify and analyze claim documentation, medical records, investigative reports, and supporting information to ensure valid claim resolution.
• Ability to read policy language and understand how it applies to claims.
• Coordinate with legal counsel on litigated claims and provide direction regarding defense strategies, settlement negotiations, and case management.
• Communicate with TPA adjusters, members, attorneys, medical providers, and other stakeholders to obtain necessary information and facilitate claim resolution.
• Analyze claims data, loss trends, and performance metrics to identify opportunities for improved claims handling, risk reduction, and operational efficiency.
• Support RMS educational initiatives through participation in Member Meetings, the Annual Meeting, webinars, and RMS publications.
• Safeguard confidential and proprietary information in accordance with organizational policies.

Qualifications

The ideal candidate is a strategic, collaborative leader with extensive experience in claims management, risk financing, and public entity insurance. This individual demonstrates sound judgment, exceptional analytical and decision-making skills, and a commitment to providing outstanding service to members while protecting the financial integrity of the Funds.

Specific qualifications include:

• Expertise in claims administration, insurance coverage, litigation management, reserve analysis, and industry best practices.
• Strong analytical, strategic thinking, negotiation, and decision-making capabilities.
• Demonstrated ability to manage complex claims independently while maintaining exceptional customer service and professionalism.
• Excellent written and verbal communication skills, including the ability to effectively communicate with members, legal counsel, medical professionals, and executive leadership.
• Strong leadership, organizational, and interpersonal skills.
• Proficiency in Origami, Microsoft Office applications, and other claims management and insurance-related software systems.
• Ability to analyze claims data and identify trends that improve operational efficiency and reduce claim costs.
• Sound judgment, critical thinking, and complex problem-solving abilities.

About GSBA

Georgia School Boards Association is a non-profit organization. Our mission is to ensure excellence in the governance of local school systems by providing leadership, advocacy and services, and by representing the collective resolve of Georgia's locally elected boards of education.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by the individual employed for this position. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required. Individuals may be required to perform duties outside of their normal responsibilities from time to time, as needed.