Claim Consultant

The Senior Claim Consultant provides complete claim loss services for policyholders.  Investigates, evaluates, and disposes of MPL and General Liability claims with varying degrees of complexity and severity. 

Essential Duties & Responsibilities

• Interview insureds, claimants, witnesses, and other appropriate parties to obtain information used to assess liability exposure. 

• Document file regarding results of investigation and negotiations. 

• Prepare reports to file on established diary dates and other specific reports as needed to ensure timely file documentation and plan of action.

• Secure records for investigation and evaluation of cases.

• Determine and implement negotiation strategy and negotiates settlements within authority level.

• Adjust reserves within level of authority and make reserve recommendations to Manager/Director for amounts over position authority level.

• Evaluate cases for appropriate disposition and seek authority for settlement from manager/director when settlement amount requests exceed authority.

• Direct and monitor activities of defense counsel in compliance with Case Management Guidelines. 

• Monitor trials and attend pre-trial proceedings, mediations, and arbitrations as necessary.

• Identify significant insured Risk Management or Underwriting issues and direct the information to appropriate department.

• Communicate with insureds, claimants, and witnesses; consult medical and other relevant records, varying methods of investigation according to type of claim.

• Analyze losses to determine if insurance coverage applies.

• Maintain working knowledge of policy forms and can confirm policy in effect for date of loss.

• Performs other duties as assigned.

Education, Experience, Competencies & Values

• Bachelor's degree from four-year college or university.

• R.N. or J.D. preferred with 5 years’ experience in clinical nursing and/or 5 years claims experience dealing with serious bodily injury. 

• Insurance adjuster's license may be required for specific states.

• Knowledge of medical, legal and insurance terminology is required.

• Must hold a current driver's license. 

• Strong written and oral communication skills. Must be comfortable making oral presentations to staff and insureds.

• Must have training in contract/policy review and application.

• Ability to read, analyze, and interpret insurance policy coverage forms, professional journals, technical procedures, or government regulations.  Ability to write reports, business correspondence, and technical case summaries.  Ability to effectively present information and respond to questions from groups of managers, insured's, agents and attorneys.

• 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.

• Experience with Microsoft Word, Excel, PowerPoint.

• Able to work with minimal supervision on a day-to-day basis.

• Occasional overnight travel may be required of this position (up to 25%).

The base salary range is $103,000 - $140,000. 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!