Senior Claim Consultant

INSURICA INC•Richardson, TX

2d•$95,000 - $110,000•Onsite

About The Position

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.

Requirements

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
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

Responsibilities

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