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Coverys · 1 week ago

Claim Consultant

Massachusetts, United States

Full-time

Hybrid

Mid, Senior Level

$88K/yr - $118K/yr

3+ years exp

Coverys is a company that provides complete claim loss services for policyholders. The Claim Consultant role involves investigating, evaluating, and disposing of MPL and General Liability claims, ensuring timely documentation and negotiation of settlements.

AnalyticsInsuranceInsurTechMedicalRisk Management

Responsibilities

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

Qualification

Claims experienceMedical terminologyLegal terminologyContract reviewData analysisOral communicationWritten communicationCreative solutions

Required

Bachelor's degree from four-year college or university

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

Ability to travel 25-30% required