Claim Consultant

Claims Consultant

The Claim Consultant will provide claim advocacy and oversight services for Tier 1, 2, and 3 clients for property and casualty and workers' compensation losses including, but not limited to, assuring complete and sound claim settlements, legal reviews and investigation, providing clients and / or carrier adjusters with leadership, direction, and problem resolution, as well as reviewing and monitoring files to ensure adjusters are achieving desired quality and service levels and functions.

Essential functions :

• Provide support to the Claim Manager to develop performance and service standards; assist in the preparation, implementation, and monitoring of the Risk Management Services department's claims management plans and client service responsibilities.
• Assist Claim Manager and / or Sr. Claim Consultant with the preparation of training seminars for clients / colleagues.
• Provide management reports, as required by senior management, to monitor performance.
• Works under the direct supervision / mentorship of the Director of Risk Services, making decisions jointly with the Director of Risk Services and / or Sr. Claim Consultant.
• Review and update EPIC with new & ongoing claims information, as needed.
• Respond to phone calls to handle difficult customers and / or claims situations with adjusters where needed; answer inquiries and questions from insureds, 3rd Party claimants, and colleagues.
• Prepare Quarterly, Semi-annual, or Annual Loss Summaries for clients.
• Prepare and provide claim summary reports for clients and producers.
• Assist in creating Special Claims Service Plans for VIP customers.
• Work / meet with clients to determine an effective claim review schedule that meets the client's needs; continually monitor and review the established schedule.
• Review policies and coverages to ensure claims are properly handled and / or paid.
• Establish and maintain effective working relationships with carrier adjusters and carrier claim consultants.
• Establish and maintain effective working relationships with clients, Producers, and Account Managers, ensuring successful collaboration on claims, as needed.
• Review all loss details for clarification of expenses versus indemnity on loss runs or closing notices; analyze claims for financial impact to client and company.
• Follow-up for subrogation, depending on the type of claim.
• Review of time lapsed from the date of loss, to the date reported, and indicate lapse times to producer and customer.
• Rectify the status of all open claims with carriers.
• Review lawsuits & claims clients; including, but not limited to, requesting public court documents and / or driver criminal records.
• Analyze / compare prior year loss runs to current year loss runs, determine if reserves are higher / lower, and refer to the type of injury.
• Effective review and analysis of new Workers' Compensation laws applicable to Texas and / or Oklahoma, remaining current on the effect on new and existing claims.
• Engages in field inspections for claims resolutions as needed.
• Engage in periodic meetings with producers and carrier claims representatives to resolve issues, or potential concerns, regarding current customers; act as the liaison between client and carrier and establish Special Handling Instructions.
• Accompany team members, as required, on prospect calls.
• Seeks assistance from Loss Control & Risk Management Services to solve high-level claims issues; involves Loss Control whenever hazards are found during the course of a claim in an effort to reduce future claim occurrences.
• Assist Producers with those Tier level customers participating in the INSURICA Work Comp Experience including, but not limited to, reviewing NCCI Worksheets and Mod-Master reports.
• Advise producers / account managers of large claims settlements / reserves per established guidelines; inform producers on the status of large claims.
• Maintain working knowledge of all established company change procedures.
• Review all activities relating to the public, customers, and companies to avoid issues involving potential errors and omissions.
• Participate in seminars and other training to maintain required licenses and pursue relevant designations / certifications, as well as for knowledge and skill development.

Additional responsibilities :

This job description is intended to describe the level of work required of the person performing the position. Essential functions are outlined; however, other duties may be assigned, as needs arise, or as required to support the essential functions. Specific performance objectives may be developed each year to measure the performance of the tasks and functions listed in this job description.

Remote work opportunities vary by location, department, and business need and are subject to change, as needed. Each manager will provide details on any telecommuting opportunities, as well as scheduling, within their department.

Knowledge, skills, and abilities :

Qualifications :

Working conditions and reasonable accommodations :