Senior Claim Consultant

Job not on LinkedIn

August 23

🚗 Michigan – Remote

Although this job is listed in Michigan, this company may be open to hiring remote in other states.

💵 $100k - $136k / year

⏰ Full Time

🟠 Senior

💼 Consultant

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Coverys

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Healthcare Insurance • Finance

Coverys is a leading provider of insurance and risk management solutions, specializing in medical professional liability insurance for healthcare professionals and organizations. With over 45 years of experience, Coverys is rated A (Excellent) and is committed to protecting healthcare providers such as doctors, surgeons, nurses, and healthcare facilities including hospitals and outpatient centers. The company offers a wide range of insurance products designed to meet the specific needs of the healthcare sector, including risk mitigation services and value-based care risk protection. Coverys is also involved in the community through the Coverys Community Healthcare Foundation, which provides charitable contributions and grant programs to support healthcare and related organizations. Driven by a mission to support and protect the healthcare community, Coverys is dedicated to innovation and improving healthcare outcomes through its suite of services.

501 - 1000 employees

Founded 2010

⚕️ Healthcare Insurance

💸 Finance

📋 Description

• The Senior Claim Consultant provides complete claim loss services for policyholders. Investigates, evaluates, and disposes of MPL and General Liability claims with varying degrees of complexity and severity. • Essential Duties & 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.

🎯 Requirements

• Bachelor's degree from four-year college or university. • R.N. or J.D. preferred with 5 years’ experience in clinical nursing and/or 5 years claims experience dealing with serious bodily injury. • Insurance adjuster's license may be required for specific states. • 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. • Ability to travel 20-25% required

🏖️ Benefits

• Benefit plans that go beyond the basics to retain and attract the very best talent.