Complex Claims Consultant-Hybrid
About The Position
This individual will proactively manage and consult on the overall claims process with specifically identified clients. The assigned clients will be in the Tier 1 Category or other specific clients as decided by management. This individual will serve as the primary claims contact and see claims through to conclusion. This individual will support the claims staff by assisting with coverage analysis and disputing denied claims. This individual will meet with clients to review loss runs or visit large losses as needed. This position may also serve as adjuster for our TPA accounts which will require Medicare reporting. This individual will review contracts as they pertain to claims for the department and assist other associates with complex claim concerns and assist the manager with customer disputes or concerns. This role strictly adheres to our Corporate Standards of Excellence and procedural guidelines spelled out in our Professional Procedure Manual.
Requirements
- Ability to read and analyze policy language for all lines of business.
- Superior customer service, negotiation and problem-solving skills.
- Superior verbal and written communication skills.
- Fluent in MS Office Products.
- Ability to utilize various software and websites.
- Excellent organizational skills and attention to detail.
- Follow through on all assigned tasks.
- Ability to absorb and retain knowledge.
- Ability to communicate clearly, to work well with others, and to manage time effectively.
- Willingness to continue with insurance education as needed for the position.
- Bachelor’s degree required.
- 10 years’ experience handling claims.
- RI adjuster’s license required.
Nice To Haves
- Master’s degree preferred or insurance designation equivalent (i.e. CPCU or CIC).
- P&C Insurance Broker license preferred.
Responsibilities
- Function as main point of contact for client.
- Address general questions, provide guidance on coverage and inform/educate clients on claims process.
- Take insured’s first notice of loss, submit to appropriate carrier.
- Manage diary system for follow up on claims.
- Manage claim life cycle for all assigned claims / accounts.
- Work with Clients on providing appropriate services based on the Tiered System.
- Analyze, consult with and review loss runs with clients when requested.
- Visit large loss sites and client meetings as needed.
- Visit loss locations where a claim is in dispute to evaluate loss as needed.
- Review contracts like lease and vendor agreements.
- Serve as off hours Claims contact on a rotating basis.
- Serve as adjuster on TPA accounts and handle claims accordingly if needed.
- Maintain ImageRight files and document activity using claims management system.
- Serve as back up to Claims Manager as needed.
- Function as main point of Claims contact for large clients.
- Work with producers on complicated coverage issues and claim scenarios for any client as requested.
- Assist Manager in resolving customer service concerns.
- Performs other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
