Claim Consultant

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.
• Determines appropriate disposition for cases 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.
• Makes sure to attend trials and attend pre-trial proceedings, mediations and arbitrations as necessary.
• Evaluates cases for appropriate disposition and seeks authority for settlement from Manager/Director when settlement amount requests exceeds authority.
• 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.

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 have the ability to design and generate creative solutions.
• Insurance adjuster's license may be required for specific states.
• Ability to travel 25-30% required.

Pay

The salary range for this role is $87,500 - $118,500. Individual compensation packages are based on a variety of factors that are unique to each candidate including location, skill set, experience, qualifications and education.