152 applicants

Company

Coverys · 1 day ago

Claim Consultant, Healthcare Programs

United States

Full-time

Remote

Mid Level

$85K/yr - $115K/yr

3+ years exp

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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

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Claim loss servicesInsurance coverage analysisNegotiation strategyMPL claimsGeneral Liability claimsMedical terminologyLegal terminologyInsurance terminologyContract reviewData collectionCreative solutions designInsurance adjuster's licenseR.N.Clinical nursing experienceClaims experienceOral presentations

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.

Insurance adjuster's license may be required for specific states.