SUMMARY:

The Claims Consultant will provide claim advocacy and oversight services for Tier 1, 2 & 3 clients for property and casualty and workers compensation losses including, but 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:

• Provide support to Claims Manager to develop performance and service standards; assist in the preparation, implementation, and monitoring of the Risk Management Services departments claims management plans and client service responsibilities
• Assist Claims Manager and/or Sr. Claim Consultant with the preparation of training seminars for clients/colleagues
• Provide management reports, as required by senior management, to monitor performance.
• Works under the direct supervision/mentorship of the Director of Risk Services, making decisions jointly with the Director of Risk Services and/or Sr. Claims Consultant
• Review and update EPIC with new & ongoing claims information, as needed
• Respond to phone calls to handle difficult customers and/or claims situations with adjusters where needed; answer inquiries and questions from insureds, 3^rd Party claimants, and colleagues
• Prepare Quarterly, Semi-annual, or Annual Loss Summaries for clients
• Prepare and provide claim summary reports for clients and producers
• Assist in creating Special Claims Service Plans for VIP customers
• Work/meet with clients to determine an effective claim review schedule that meets the client's needs; continually monitor and review the established schedule
• Review policies and coverages to ensure claims are properly handled and/or paid
• Establish and maintain effective working relationships with carrier adjusters and carrier claim consultants
• Establish and maintain effective working relationships with clients, Producers, and Account Managers, ensuring successful collaboration on claims, as needed
• 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 the date of loss, to the date reported, and indicate lapse times to producer and customer
• Rectify the status of all open claims with carriers
• Review lawsuits & claims for Tier 2 & 3 clients; including, but not limited to, requesting public court documents and/or driver criminal records
• Analyze/compare prior year loss runs to current year loss runs, determine if reserves are higher/lower, and refer to the type of injury
• Review and analysis of new Worker's Compensation laws applicable to Texas and/or Oklahoma, remaining current on the effect on new and existing claims
• Engages in field inspections for claims resolutions as needed
• Engage in periodic meetings with producers and carrier claims representatives to resolve issues, or potential concerns, regarding current customers; act as the liaison between client and carrier
• Accompany team members, as required, on prospect calls
• 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 participating 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 on the status of large claims
• Maintain working knowledge of all established company change procedures
• 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 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.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Possess excellent negotiation skills
• Imaginative and creative with excellent problem-solving skills
• Ability to work within a fast-paced, changing priority environment
• Previous working experience with high-dollar complex property claims
• 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, and in writing
• Ability to prepare and deliver effective presentations
• 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:

• 15+Years of Worker's Compensation and/or casualty claims experience preferred
• Bachelor's degree (business, accounting, marketing) preferred
• Professional insurance-related designations are highly desirable
• Must possess all licenses, as required by the appropriate State Department of Insurance, if applicable

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

Compensation and Benefits

The expected base compensation for this role is $52,448 to $89,280. The base compensation offered will be determined on a case-by-case basis accounting for the applicants experience, skills, certifications, education, and location. In addition to the base compensation, this position may be eligible for additional performance-based incentive compensation which can be discussed during the interview process. In addition to compensation, INSURICA offers a competitive total awards package including health and welfare benefits, paid time off, volunteer time off, tuition assistance, 401(k), and employee assistance plans. Thanks to our colleagues, INSURICA also provides an award-winning culture, being named the Best Independent Agency to Work for in America by Insurance Journal in 2022.