Job Description

Claims Consultant

Job Summary

Seeking a highly skilled and experienced Claims Consultant to serve as a vital liaison between Producers and insured clients. The ideal candidate will play a key role in resolving complex claims issues, providing expert guidance, and ensuring smooth communication between all stakeholders. This position requires a professional with a strong background in claims management, excellent communication skills, and the ability to think analytically in challenging situations.

Compensation Package

• Competitive salary commensurate with experience
• Comprehensive benefits package, including health, dental, and vision insurance
• Paid time off and holidays
• Opportunities for professional development and certification reimbursement

Responsibilities

• Review and obtain status updates on loss runs during account renewals or as needed.
• Attend prospective customer sales presentations to highlight the value-added services of the claims department.
• Investigate individual claims identified by Producers or accounts, ensuring appropriate handling and reserving value.
• Propose alternative methods for resolving claims, assist insured clients with Return-to-Work plans, and identify suitable treatment specialists or resources.
• Provide technical guidance on claims procedures and coverage to Producers, Customer Service Representatives (CSRs), and insured clients.
• Conduct claims review meetings with insured clients, Producers, and claim representatives.
• Deliver onsite training for insured clients on claims reporting procedures, returning injured workers to the job, and mitigating Employment Practices Liability exposures.
• Advocate for insured clients in coverage disputes with insurance companies and assist in analyzing coverage issues.
• Organize technical presentations for Producers, CSRs, and customers on claims-related topics.
• Evaluate injury types, accident trends, location patterns, and communication barriers to improve claims outcomes.
• Establish and maintain a preferred medical treatment network for workers’ compensation injuries.
• Foster strong communication links with various insurance claims departments.
• Perform other duties as assigned.

Qualifications/Requirements

Education/Experience

• Bachelor’s degree required.
• Minimum of 15 years of experience in claims management, including roles as a Claim Representative, Claim Supervisor, and Claim Consultant.
• Multi-line claims background, including Workers’ Compensation, Liability, and Property.

Licensure/Certification

• Associate in Claims (AIC) certification.
• Associate in Risk Management (ARM) certification.

Personal Characteristics

• Exceptional communication skills with the ability to handle difficult situations and individuals effectively.
• Strong analytical thinking and problem-solving abilities.
• Proven ability to resolve disputes between Claim Representatives and insured clients.
• Reliable and punctual with a commitment to professional excellence.

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