Claim Consultant, Healthcare Programs

The Claim Consultant, Healthcare Programs provides complete claim loss services for policyholders. This role will investigate, evaluate and dispose of MPL and General Liability claims with varying degrees of complexity and severity. The Claim Consultant works independently to provide claim-loss service for Coverys policyholders. This role will investigate and adjust claims with high levels of complexity and severity.

Essential Duties & Responsibilities

• Interviews insureds, claimants, witnesses and other appropriate parties to obtain information used to assess liability exposure. 
• Documents related files regarding results of investigation and negotiations. 
• Prepares reports to file on established diary dates and other specific reports as needed to ensure timely file documentation and plan of action.
• Secures records for investigation and evaluation of cases.
• Determines and implements negotiation strategy and negotiates settlements within authority level.
• Timely adjusts reserves within level of authority and makes reserve recommendations to Manager/Director for amounts over position authority level.
• Advises Claim Director and/or S.V.P. of Claims on claims status and attends Reserve & Settlement Committee Meetings as necessary.  Ensures timely reporting to the Reserve and Settlement Committee.
• Interacts with other departments as necessary to help facilitate and coordinate services to our insured and client.
• Evaluates cases for appropriate disposition and seeks authority for settlement from Manager/Director when settlement amount requests exceeds authority.
• Directs and monitors activities of defense counsel in compliance with Case Management Guidelines. 
• Monitors trials and attends pre-trial proceedings, mediations and arbitrations as necessary.
• Identifies significant insured Risk Management or Underwriting issues and directs the information to appropriate department.
• Communicates with insureds, claimants and witnesses; consults medical and other relevant records, varying methods of investigation according to type of claim.
• Analyzes and verifies insurance coverage for claims brought against policyholders.
• Maintains working knowledge of policy forms and can confirm policy in effect for date of loss.

Education, Requirements & Competencies

• Bachelor's degree from four-year college or university
• R.N. or J.D. preferred with 3-5 years’ experience in clinical nursing and/or 3-5 years claims experience dealing with serious bodily injury. 
• Knowledge of medical, legal and insurance terminology is required.
• Must hold a current driver's license. 
• Strong written and oral communication skills.
• Must have training in contract/policy review and application.
• Must be comfortable making oral presentations to staff and insureds.
• Must be able to synthesize complex or diverse information; Collect and research data; use intuition and experience to complement data; design workflows and procedures.
• Must have the ability to design and generate creative solutions.
• Insurance adjuster's license may be required for specific states.

The base salary range is $85,000 - $115,000. Individual compensation packages are based on a variety of factors that are unique to each candidate including geographic location, skill set, experience, qualifications and education.

If you're a caring and customer focused individual who enjoys working with passionate team members, Coverys is the right company for you!