SUMMARY:
The Senior Claims Consultant will provide claim advocacy and oversight services for Tier 1, 2 & 3 clients for property and casualty and worker's compensation losses. Services include but are 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:
- Work directly with the Claims 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
- Provide management reports as required by senior management to monitor performance
- Trains and mentors junior claim colleagues as needed
- Will undergo training and mentorship from the Director of Risk Management Services as needed
- Evaluate claim documentation to ensure coverage accuracy
- Update EPIC with new & ongoing claims information, as needed
- Respond to phone calls to handle difficult customers 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
- Assist Claims Manager in creating Special Claims Service Plans for VIP customers
- 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 date of loss to date reported and indicate lapse times to producer and customer
- Rectify with carriers the status of all open claims
- Review client lawsuits, larger losses (large reserves), and more complex claims and coverage scenarios
- Compare prior year loss runs to current year loss runs (reserve analysis for Work Comp loss runs) to determine if reserves are higher/lower, and refer to the type of injury
- Review and prepare an analysis of new Work Comp laws applicable to Texas and/or Oklahoma
- Engages in field inspections for claim resolutions as needed
- Periodic meetings with producers and carrier claims representatives to solve issues or potential concerns regarding current customers, acting as liaisons between client and carrier (including client claim reviews) , and establishing Special Handling Instructions
- Accompany Team members on prospect calls when necessary
- Seeks assistance from Loss Control & Risk Management Services to solve high-level claims issues. Involve 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 enrolled 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 of the status of large or complex claims
- Maintain and distribute Agency Claims Log, Large Loss Reports, and Litigated Claims Reports
- Maintain working knowledge of all company change procedures
- Conduct claims training seminars for clients and colleagues
- Stays current on developing legislative & regulatory changes that will impact INSURICA claims advocacy efforts and educate clients & colleagues of these changes
- 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/maintain 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:
- Imaginative and creative with excellent negotiation and problem-solving skills
- Creative and analytical, with the ability to influence others
- Excellent computer skills, including the Microsoft Office suite of products (Word, Excel, PowerPoint, Outlook, Teams, etc.), with the ability to create spreadsheets, graphics, charts, diagrams, and other illustrations for presentations and reports, as well as be able to effectively utilize the agency management systems
- Ability to work within a fast-paced, changing priority environment
- Self-motivated, with the initiative to prioritize and be self-directed
- Regular and punctual attendance is required
- Ability to listen to a question, analyze and work through the problem, and explain the solution to the inquiring person so that he/she is confident in his/her ability to complete the task on their own
- Ability to thoroughly understand written and oral communication and interpret abstract information
- Attentive to details and have a good understanding of the claims workflow, systems, and processes.
- Ability to communicate effectively, both verbally, in writing, and across all levels
- Excellent interpersonal skills, with the ability to interact effectively with both colleagues and managers, across all levels
- Ability to promote and maintain a team environment, willing to find accommodating solutions for our customers, companies, and the Agency
- Ability to successfully adhere to company policies and procedures, as well as maintain strict confidentiality
QUALIFICATIONS:
- 10+ Years of workers’ compensation and/or casualty claims experience preferred
- Bachelor’s degree (business, accounting, marketing) preferred
- Professional insurance-related designations are highly desirable
- Possess all licenses, as required by the appropriate State Department of Insurance, if applicable.
- Possession of, or the ability to acquire within one year, an adjuster’s license, is required
WORKING CONDITIONS AND REASONABLE ACCOMMODATIONS:
- Fast-paced, multi-tasking, office environment with periodic high disruption and changing priorities
- Ability to perform approximately 80% sedentary work, exerting up to 10 pounds of force occasionally, and negligible force frequently
- Ability to lift up to 20 pounds occasionally
- Requires operation of a computer workstation, including keyboard and video display
- All requirements may be modified to reasonably accommodate physical or mental impairment
