Claim Consultant

INSURICA, Inc•Bakersfield, CA

5d•$83,000 - $102,000

About The Position

The Claim Consultant will provide claim advocacy and oversight services for Tier 1, 2 & 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.

Requirements

Imaginative and creative with excellent negotiation and problem-solving skills
Ability to work independently and with authority to make decisions based on experience and business need
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 effectively discuss coverages, and the claim process, with clients
Proficiency in monitoring claims, efficiently and proactively ensuring accuracy and compliance with company standards
Effectively evaluate claim documentation to ensure coverage accuracy
Knowledgeable of insurance coverages to accurately access claims and carrier decisions regarding claims and coverage.
Ability to negotiate and influence outcomes effectively
Ability to prioritize work in a fast-paced environment and meet deadlines with limited oversight from management
Ability to identify discrepancies and resolve issues promptly.
Ability to handle difficult situations and resolve conflicts professionally
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, and 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
5 – 7 Years of Worker's Compensation and/or casualty claims experience required
Bachelor’s degree preferred
Litigated claim experience preferred
Possess all licenses, as required by the appropriate State Department of Insurance, if applicable, required
Possession of, or the ability to acquire within one year, an adjuster’s license, is required
Professional insurance-related designations preferred

Responsibilities

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, Producer,s 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