Claims Technical Consultant

Responsibilities

• Resolve highly complex commercial casualty claims at the highest authority levels.
• Deliver effective and efficient claims resolutions.
• Provide technical leadership within the claims organization.
• Examine and analyze policies, contracts, and claim forms to determine coverage on complex and multi-party casualty claims.
• Determine liability by gathering and analyzing relevant facts and applying applicable law and negligence principles.
• Investigate losses via telephone, correspondence, or on-site inspection.
• Request and review reports such as police reports, fire reports, medical records, and property inspections.
• Review and hire liability and medical experts for litigated and pre-suit claims.
• Utilize independent adjusting services when appropriate.
• Establish and continually reevaluate accurate claim reserves throughout the lifecycle of the claim.
• Manage litigation by assigning counsel, establishing litigation plans and budgets, coordinating defense activities, reviewing settlement potential, and authorizing payments.
• Enter claim data accurately into claim systems for reporting purposes.
• Collaborate on subrogation, arbitration, and salvage recovery.
• Conduct Medicare lien analysis and negotiate liens when applicable.
• Recommend and coordinate with outside legal counsel regarding defense strategy, including settlement or trial decisions.
• Provide technical advice, direction, training, and mentoring to claims staff.
• Attend settlement conferences, depositions, mediations, pre-trial hearings, and trials as needed.
• Contribute to profitable growth by providing risk insights and trends to business units and customers.
• Maintain professional and technical knowledge through education, networking, and industry engagement.
• Stay current on legal and coverage trends across jurisdictions.
• Act as a technical expert for internal teams and business partners.
• Provide insights to improve product offerings, risk assessments, and policy language.
• Present complex claims to senior leadership for authority and strategic direction.

Qualifications

• Effective verbal and written communication skills.
• Ability to accurately keyboard and utilize multiple computer systems.
• Ability to perform multiple duties in a fast-paced environment.
• High level of professionalism with internal and external customers.
• Strong organizational and prioritization skills.
• Advanced insurance coverage evaluation skills.
• Proven litigation management skills.
• Effective presentation skills.
• Advanced negotiation experience.
• Strong analytical, critical thinking, and problem-solving skills.
• Experience with collaborating in a team environment and building cross-functional relationships.
• Proactively shares and promotes insights.
• Ability to gather perspectives from multiple teams to optimize outcomes.
• Ability to analyze and apply insurance policy components for complex claims.
• Ability to follow reserving processes for indemnity and expense.
• Ability to determine scope and exposure of complex claims.
• Ability to leverage trends and relationships to provide high-quality customer service.
• Strong understanding of financial and actuarial trends and concepts.
• Ability to communicate coverage determinations effectively to customers, clients, and brokers.

Education

• Bachelor’s Degree and 15 or more years of casualty claims adjusting experience, including 10 years of complex casualty claims adjusting experience, or
• Juris Doctor and 5 or more years of experience in Claims and Litigation Management.

Additional Company Details

• The company offers a competitive compensation plan and robust benefits package for full time regular employees including:
• Health, dental, vision, life, disability, wellness, paid time off, 401(k) and profit-sharing plans.
• The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.