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Senior Claim Consultant

INSURICA, Inc. -
Richardson, TX

Apply Now

Job Details

Full-time
$95,000 - $110,000 a year

Qualifications

Legislative analysis
Computer operation
Casualty insurance experience
Insurance products customer support
Customer training
Confidential information handling
Microsoft Outlook
Illustration
Legal analysis
Phone communication
Marketing
Team leadership
Spreadsheets
Writing skills
Client inquiry handling
In-person customer service
Bachelor's degree in business
Performance Reporting
Claims negotiation
Client relationship development
Performance management
Financial analysis experience
Workers' compensation insurance knowledge
Regulatory legal research
Bachelor's degree in marketing
Legislative regulatory analysis
Analysis skills
Phone customer support
Bachelor's degree
Loss control

Full Job Description

SUMMARY:

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.

ESSENTIAL FUNCTIONS:

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

ADDITIONAL RESPONSIBILITIES:

This job description is intended to describe the level of work required of the person performing the position. Essential functions are outlined; however, other duties may be assigned, as needs arise, or as required to support the essential functions. Specific performance objectives may be developed each year to measure the performance of the tasks and functions listed in this job description.

Remote work opportunities vary by location, department, and business need and are subject to change, as needed. Each manager will provide details on any telecommuting opportunities, as well as scheduling, within their department.

KNOWLEDGE, SKILLS, AND ABILITIES:

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

QUALIFICATIONS:

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

WORKING CONDITIONS AND REASONABLE ACCOMMODATIONS:

Fast-paced, multi-tasking, office environment with periodic high disruption and changing priorities
Ability to perform approximately 80% sedentary work, exerting up to 10 pounds of force occasionally, and negligible force frequently
Ability to lift up to 20 pounds occasionally
Requires operation of a computer workstation, including keyboard and video display
All requirements may be modified to reasonably accommodate physical or mental impairment

Apply Now

Refine Your Search

Claim Resolution Representative jobs

Senior Claim Consultant

General Liability Inside Claim Representative

Outside Property Claim Representative

EMS Patient Account Representative

Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)

Customer Service Representative

Work from Home: Customer Service Representative (Healthcare)

Medicare Account Resolution Specialist - Digitech - Remote

Allowables Representative

Technical Specialist, Construction Claim

Remote Healthcare Customer Service Representative

Healthcare Customer Service Representative

Customer Service Representative I

Account Resolution Specialist - Insurance HMOs - Digitech - Remote

Insurance Account Resolution Specialist - Digitech - Remote

Supervisor (Clinical Adjudication) Weekday Evening Shift - Flexible Scheduling (Part C)

Customer Service Representative

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(Remote) Account Follow-Up Representative I

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