Sr Consultant Casualty Claims

Hanover Insurance Group•Southfield, MI

3d•Hybrid

About The Position

The Sr Consultant Casualty Claims is responsible for managing high-complexity no-fault claims involving moderate to high injury and disability severity. Duties include thorough coverage analysis, evaluating medical bills and other no-fault benefits for payment consideration, coordination and contact with claimants, third-parties and medical providers, skillfully negotiating settlements, and/or oversight of litigation strategy. Consultants may collaborate with legal counsel, SIU teams, and medical experts to resolve claims efficiently while ensuring compliance with no-fault statutes and contributing to mentoring early in career staff. Key responsibilities include representing the company in various forums related to claims litigation, maintaining a high standard of professionalism, and ensuring compliance with regulatory and company standards. The role demands strategic thinking, sound judgment, and the ability to navigate sensitive and high-impact claim scenarios.

Requirements

Bachelor’s degree preferred, or a combination of education and equivalent experience.
Typically requires 5–10 years of claims handling experience.
Skilled in negotiating complex claims and developing strategies to influence outcomes.
Demonstrates sound judgment and decision-making on high-exposure cases, including litigation and compliance matters.
Communicates clearly and effectively in both verbal and written formats across a variety of situations.
Selects appropriate communication channels and consistently demonstrates empathy toward all stakeholders.
Maintains comprehensive and organized claim records and prepares detailed reports summarizing findings and recommendations.
Highly organized with the ability to manage complex workflows and participate in project work.
Demonstrates strong time management and desk management skills, and mentors others in these areas.
Makes informed decisions based on thorough analysis of complex issues.
Evaluates risks and outcomes, acts independently within authority, and identifies patterns in claims to support resolution strategies.
Highly skilled in investigating complex cases and collaborating with internal and external experts.
Coordinates closely with legal, underwriting, and other stakeholders to ensure thorough evaluation.
Possesses in-depth understanding of the regulatory environment and jurisdictional requirements.
Handles complex compliance issues and mentors others on regulatory standards.
Provides exceptional, empathetic customer service.
Effectively manages escalated claims and sensitive customer concerns with professionalism and clarity.
Analytical Reasoning: The ability to identify problems, understand your impact, gather input and data, and develop an effective solution.
Customer Centricity: Makes customers/clients and their needs a primary focus of one’s actions; shows interest in and understanding of the needs and expectations of internal and external customers; gains customer trust and respect; meets or exceeds customer expectations.
Digital Fluency: Effectively uses digital tools and technology appropriately to find, evaluate, create, and communicate information understands how to navigate digital platforms, use software applications, and leverage technology for productivity and communication purposes.
Persuasion and Influence: Uses appropriate interpersonal skills and techniques to gain acceptance for ideas or solutions; uses influencing strategies to gain genuine agreements; seeks to persuade rather than force solutions or impose decisions or regulations.
Professional Insurance Acumen: Demonstrates a deepening understanding of the insurance industry and the ability to apply specialized technical skills to address complex challenges, adapt to industry trends, and drive value for the organization.
Planning and Execution: Plans, prioritizes and manages resources and time effectively to achieve specific goals or deadlines.

Responsibilities

Independently manage moderate to complex, high-value casualty claims, ensuring thorough analysis and resolution.
Lead thorough investigations, assess coverage, and issue appropriate documentation including reservation of rights and coverage letters.
Escalate issues as needed.
Identify opportunities to transfer risk and pursue subrogation.
Proactively resolve disputes, deescalate sensitive situations, and ensure optimal claim outcomes through strategic negotiation and litigation management.
Ensure all claims activities comply with regulatory and company standards.
Maintain accurate, detailed records and prepare comprehensive reports.
Execute jurisdictional compliance requirements and support others in understanding regulatory obligations.
Set reserves, authorize payments, and make financial decisions within authority.
Demonstrate strong financial acumen and contribute to reserving accuracy and efficiency.
Coordinate with internal and external stakeholders including legal, underwriting, vendors, and agents.
Lead cross-functional meetings and communicate complex information clearly to diverse audiences.
Use advanced tools and analytics to identify trends, correct inconsistencies, and improve claims handling efficiency.
Ensure proper data ingestion, labeling, and protection of personally identifiable information (PII).
Serve as a mentor to junior claim handlers, providing guidance on complex claims, compliance, and litigation processes.
Support training initiatives and contribute to the development of best practices and educational materials.
Deliver empathetic, clear communication throughout the claims process.
Educate claimants and stakeholders, affirm next steps, and ensure a positive customer experience.
Attend industry events and continuing education seminars to stay current with best practices, legal developments, and emerging trends.
Must possess or obtain and maintain appropriate state adjuster licenses and continuing education credits.