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Coverys · 2 days ago

Senior Claim Consultant

Pennsylvania, United States

Full-time

Hybrid

Mid, Senior Level

$103K/yr - $140K/yr

5+ years exp

Coverys is a company that provides claim loss services for policyholders. The Senior Claim Consultant is responsible for investigating, evaluating, and disposing of MPL and General Liability claims, ensuring timely documentation and effective negotiation strategies.

AnalyticsInsuranceInsurTechMedicalRisk Management

Responsibilities

Interview insureds, claimants, witnesses, and other appropriate parties to obtain information used to assess liability exposure

Document file regarding results of investigation and negotiations

Prepare reports to file on established diary dates and other specific reports as needed to ensure timely file documentation and plan of action

Secure records for investigation and evaluation of cases

Determine and implement negotiation strategy and negotiates settlements within authority level

Adjust reserves within level of authority and make reserve recommendations to Manager/Director for amounts over position authority level

Evaluate cases for appropriate disposition and seek authority for settlement from manager/director when settlement amount requests exceed authority

Direct and monitor activities of defense counsel in compliance with Case Management Guidelines

Monitor trials and attend pre-trial proceedings, mediations, and arbitrations as necessary

Identify significant insured Risk Management or Underwriting issues and direct the information to appropriate department

Communicate with insureds, claimants, and witnesses; consult medical and other relevant records, varying methods of investigation according to type of claim

Analyze losses to determine if insurance coverage applies

Maintain working knowledge of policy forms and can confirm policy in effect for date of loss

Performs other duties as assigned

Qualification

Insurance adjuster's licenseMedical terminology knowledgeLegal terminology knowledgeClaims experienceContract/policy review trainingMicrosoft Office proficiencySynthesize informationCommunication skillsCreative problem-solving

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 be comfortable making oral presentations to staff and insureds

Must have training in contract/policy review and application

Ability to read, analyze, and interpret insurance policy coverage forms, professional journals, technical procedures, or government regulations

Ability to write reports, business correspondence, and technical case summaries

Ability to effectively present information and respond to questions from groups of managers, insured's, agents and attorneys

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

Experience with Microsoft Word, Excel, PowerPoint

Able to work with minimal supervision on a day-to-day basis

Occasional overnight travel may be required of this position (up to 25%)