Senior Risk Management Claims Consultant

Community Financial System, Inc.•Syracuse, NY

About The Position

The Senior Claims Consultant is a highly experienced, client-facing technical advisor who leads claims advocacy and strategic consultation across commercial Property & Casualty lines, excluding Workers’ Compensation. The role helps clients understand how to prepare for, report, and respond to losses; engages appropriate carrier resources; monitors claim direction; and communicates clear, practical guidance to clients and internal teams. The consultant independently leads complex, high-severity, litigated, sensitive, or coverage-challenged claims, coordinating with leadership, legal counsel, and specialists when formal legal interpretation, executive authority, or additional support is needed. The position also contributes claims expertise to client onboarding, renewals, stewardship, and new-business activities. It provides carrier navigation and accountability, coverage consultation, client education, claims analytics, executive-level summaries, and technical guidance to colleagues. The role maintains claim documentation in Applied Epic or other approved systems, protects confidential information, contributes to service standards and process improvement, and represents Claims in strategic client and carrier discussions. Routine travel to client, carrier, and OneGroup locations is required.

Requirements

At least seven years of progressively responsible commercial P&C claims experience with a carrier, TPA, brokerage, independent adjusting firm, or comparable claims organization, including direct responsibility for complex or high-severity matters.
Broad working knowledge of commercial property, general liability, and commercial auto claims, with the ability to recognize issues across specialty P&C lines.
Demonstrated ability to communicate and negotiate effectively with insurance carriers, adjusters, clients, counsel, vendors, and internal business partners.
Experience reviewing claim developments, coverage correspondence, reserves, litigation activity, settlement considerations, and carrier service performance.
Strong client presence, written communication, organization, follow-through, judgment, and ability to manage multiple active matters.
Comfort working in Applied Epic or a similar agency or claims-management system and proficiency with Microsoft 365 tools.
Client advocacy and consultative presence; commercial P&C claims judgment; carrier navigation and constructive influence; coverage and policy analysis; negotiation, escalation, and conflict resolution; clear executive and client communication; analytical thinking and business acumen; relationship management and collaboration; documentation discipline and professional discretion; adaptability, curiosity, and continuous improvement.
Routine travel to client, carrier, and OneGroup locations is required.

Nice To Haves

Associate or bachelor’s degree in insurance, risk management, business, finance, or a related field.
Associate in Claims (AIC), Chartered Property Casualty Underwriter (CPCU), Associate in Risk Management (ARM), or comparable designation.
Property & Casualty producer license and/or appropriate adjuster licensing based on jurisdiction and assigned duties.
Experience with large, complex, or multi-location commercial clients; claim reviews; stewardship; loss-run analysis; and executive presentations.
Experience building productive working relationships within carrier claims organizations and navigating supervisory escalation channels.
Demonstrated experience mentoring claims professionals, leading technical reviews, or developing claims practices and service standards.

Responsibilities

Serve as the senior claims advisor and lead advocate for assigned clients’ complex, high-severity, litigated, sensitive, or strategically important commercial P&C claims, excluding Workers’ Compensation.
Assess claim facts, urgency, operational impact, coverage concerns, and client needs, then establish an appropriate engagement plan and claim strategy.
Guide clients on immediate actions, documentation, evidence preservation, communication protocols, and realistic next steps without providing legal advice.
Coordinate claim stakeholders, monitor action plans and execution, and escalate matters when formal legal interpretation, executive authority, or extraordinary exposure requires additional support.
Provide proactive, plain-language updates on material developments, business implications, open questions, responsibilities, and next actions.
Lead large-loss reviews, claim strategy meetings, war rooms, stewardship discussions, executive claim presentations, and post-loss debriefs.
Build trusted relationships with client leadership, risk contacts, Producers, Account Executives, Account Managers, and internal partners.
Liaise between clients and carriers, TPAs, adjusters, counsel, experts, or vendors; engage carrier staff to clarify strategy, obtain timely responses, address stalled activity, and resolve service concerns.
Review claim action plans, investigations, liability assessments, reserves, settlement posture, litigation developments, and closure opportunities.
Advocate for appropriate carrier review when claim handling, communication, reserves, or coverage positions appear inconsistent with available facts, policy language, or service expectations; escalate unresolved concerns through appropriate channels.
Document carrier contacts, processes, knowledge, and lessons in reusable playbooks, and provide claims-based feedback for carrier selection, placement, renewals, and relationship discussions.
Review policy language, endorsements, exclusions, deductibles, retentions, reservation-of-rights letters, coverage positions, and denials; explain potential coverage and handling issues while distinguishing OneGroup’s advocacy role from the carrier’s authority to determine coverage.
Recognize and escalate disputed coverage, significant financial exposure, litigation, reputational risk, unusual facts, and potential errors and omissions exposure.
Identify potential subrogation, tender, contractual indemnification, risk-transfer, recovery, and evidence-preservation opportunities; coordinate with leadership or legal counsel when formal interpretation or privileged advice is required.
Participate in new-client onboarding, carrier transitions, renewals, and service planning to establish expectations before a loss occurs.
Help clients understand incident reporting contacts and processes, information to preserve, and what to expect from carriers; develop practical claim-reporting guides, emergency-response checklists, documentation tools, and educational resources.
Adapt claim guidance to exposures such as property damage, automobile accidents, premises liability, and cyber events; conduct post-loss reviews and recommend improvements to client procedures, handoffs, reporting, and loss mitigation.
Review loss runs and claim inventories for severity, duration, reserve movement, closure activity, recurring causes, and carrier performance; translate findings into recommendations for service plans, stewardship, renewals, retention, and risk mitigation.
Prepare concise executive-level claim summaries and presentations connecting technical developments to operational and financial implications; partner with Risk Management Consultants on prevention and mitigation opportunities.
Support prospective-client and retention discussions when claims expertise can strengthen OneGroup’s value proposition; document client touchpoints, recommendations, commitments, and outcomes.
Maintain accurate, timely, decision-useful claim documentation in Applied Epic and other approved systems; use established workflows, templates, automation, and approved AI-enabled tools while preserving professional judgment and data quality.
Coordinate with Claims Intake, account service, Risk Management, Producers, and senior claims resources, ensuring clear handoffs and ownership; escalate complex matters with concise summaries and recommended next steps.
Contribute to carrier playbooks, claim procedures, service standards, escalation matrices, client resources, and continuous process improvement; identify opportunities to improve workflows, technology, automation, role clarity, and measurable client value.
Protect confidential information and follow applicable privacy, cybersecurity, documentation, licensing, and E&O risk-management requirements.
Represent Claims in strategic client, prospect, renewal, carrier, and cross-functional conversations; review significant claims and emerging portfolio patterns for systemic carrier, coverage, process, or client-risk concerns.
Lead the development and consistent application of P&C claims service standards, complexity criteria, escalation protocols, carrier playbooks, and client-facing resources.
Coach and provide practical guidance to Claims Consultants, intake professionals, Producers, Account Executives, Account Managers, and Risk Management Consultants on claim strategy, coverage concerns, carrier escalation, client communication, documentation, and professional judgment.