Claim Consultant
- Interviews insureds, claimants, witnesses and other appropriate parties to obtain information used to assess liability exposure.
- Documents related files regarding results of investigation and negotiations.
- Prepares reports to file on established diary dates and other specific reports as needed to ensure timely file documentation and plan of action.
- Secures records for investigation and evaluation of cases.
- Determines and implements negotiation strategy and negotiates settlements within authority level.
- Timely adjusts reserves within level of authority and makes reserve recommendations to Manager/Director for amounts over position authority level.
- Advises Claim Director and/or S.V.P. of Claims on claims status and attends Reserve & Settlement Committee Meetings as necessary. Ensures timely reporting to the Reserve and Settlement Committee.
- Interacts with other departments as necessary to help facilitate and coordinate services to our insured and client.
- Evaluates cases for appropriate disposition and seeks authority for settlement from Manager/Director when settlement amount requests exceeds authority.
- Directs and monitors activities of defense counsel in compliance with Case Management Guidelines.
- Monitors trials and attends pre-trial proceedings, mediations and arbitrations as necessary.
- Identifies significant insured Risk Management or Underwriting issues and directs the information to appropriate department.
- Communicates with insureds, claimants and witnesses; consults medical and other relevant records, varying methods of investigation according to type of claim.
- Analyzes and verifies insurance coverage for claims brought against policyholders.
- Maintains working knowledge of policy forms and can confirm policy in effect for date of loss. Education, Requirements & Competencies
- Bachelor's degree from four-year college or university
- R.N. or J.D. preferred with 3-5 years' experience in clinical nursing and/or 3-5 years claims experience dealing with serious bodily injury.
- Knowledge of medical, legal and insurance terminology is required.
- Must hold a current driver's license.
- Strong written and oral communication skills.
- Must have training in contract/policy review and application.
- Must be comfortable making oral presentations to staff and insureds.
- Must be able to synthesize complex or diverse information; Collect and research data; use intuition and experience to complement data; design workflows and procedures.
- Must have the ability to design and generate creative solutions.
- Insurance adjuster's license may be required for specific states.
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