PIP - Consultant Casualty Claims

About the role

The Consultant Casualty Claims is responsible for managing no-fault claims that typically involve minimal to moderate injury and disability severity. Duties include verifying coverage, evaluating medical bills and applicable no-fault benefits for payment, and maintaining clear communication with claimants, third parties and providers.

Responsibilities

• Manage a caseload of moderately complex casualty claims from intake through resolution.
• Conduct thorough investigations, assess liability, and evaluate damages using established procedures.
• Collaborate with underwriting, legal, and internal/external stakeholders as needed to ensure comprehensive claim evaluation.
• Identify and refer potentially suspicious claims to the Special Investigations Unit.
• Apply comparative negligence laws and state-specific regulations to claim assessments.
• Set reserves, authorize payments, and demonstrate financial acumen within scope of authority.
• Utilize technology and data tools to enhance claims processing efficiency and accuracy.
• Communicate directly with claimants, legal representatives, and third parties to negotiate fair resolutions.
• Maintain detailed and compliant documentation of claim activities and communications.
• Participate in team collaboration, problem-solving discussions, and cross-functional coordination.
• Support subrogation efforts and risk transfer opportunities to benefit insureds and business partners.
• Handle sensitive communications professionally and translate complex information for diverse audiences.
• Mentor entry-level claim handlers and share best practices learned through training and experience.
• Attend ongoing training and education to maintain licensing and stay current on industry standards.
• Independently manage indemnity, medical, and basic arbitration or mediation components of claims with supervisory support.

Requirements

• Associate degree required; bachelor's degree preferred or combination of education and experience.
• Typically has 1-4 years of relevant claims handling experience.
• Conduct independent analysis of contractual indemnification.
• Independently execute indemnity, medical, litigation/resolution management.
• Proficient with basic computer navigation; ability to use basic software systems/applications (Suite of MS Office Products) and use of internet.
• Learn and handle negotiations independently within authority, understand common tactics for moderately complex claim resolution.
• Use judgement and effectively utilize the most suitable communication channel while displaying empathy towards all stakeholders.
• Knowledge of various types of insurance products and processes.
• Conduct thorough investigations; identify key issues and gather evidence.
• Provide effective empathetic customer service; handle routine inquiries and issues.

Qualifications

• Knowledge of comparative negligence laws and state-specific regulations.
• Ability to set reserves and authorize payments.
• Experience with technology and data tools for claims processing.
• Effective communication and negotiation skills.
• Ability to conduct thorough investigations and gather evidence.
• Customer service skills.
• Basic computer navigation and proficiency with MS Office products.

Skills

• Analytical Reasoning
• Customer Centricity
• Digital Fluency
• Persuasion and Influence
• Professional Insurance Acumen
• Planning and Execution

Benefits

• Medical, dental, vision, life, and disability insurance
• 401K with a company match
• Tuition reimbursement
• PTO
• Company paid holidays
• Flexible work arrangements
• Cultural Awareness Day in support of IDEOn-site medical/wellness center (Worcester only)

Pay

The target hiring range for this role may vary based on geographic location and other factors, including merit or performance, demonstrated proficiency, skills for the role, education, travel requirements, and experience. Additional compensation may include an annual bonus (which could take the form of a general bonus, sales incentive, or short-term incentive), long-term incentive or spot recognition awards.

Schedule

Full-time, exempt role with a hybrid work schedule (two days in the office).