Claim Consultant

Employer
Coverys
Location
Columbus, Ohio
Salary
Competitive Salary, Full Benefits Package, Bonus Eligibility
Posted
Apr 03, 2019
Closes
Jun 02, 2019
Ref
60019004
Category
Claims
Job Type
Full Time

A Company That Strives to Improve Outcomes

Providing unique services that go above and beyond to protect and support our clients in the delivery of healthcare, is who we are. We stand apart from other medical liability insurance companies by providing services that leverage data analytics to reduce risks, and though leadership articles, blogs, white papers, and educational materials to improve patient outcomes. We don’t settle for business as usual, and we strive to be leaders in the evolving healthcare market. Our core product may be trusted insurance, but we package and deliver it with so much more. If you are ready to contribute to a company that is taking its industry by storm and making a difference in healthcare, Coverys is for you.

Our Claim Consultants provide complete claim loss services for policyholders.  This role will investigate, evaluate and dispose of MPL and General Liability claims with varying degrees of complexity and severity.   The Claim Consultant works independently to provide claim-loss service for Coverys policyholders.  He/she will investigate and adjust claims with high levels of complexity and severity. 

This is a remote position supporting our Ohio territory.  Qualified candidates will need to reside in the state in order to provide the required level of service to our insureds.

Essential Duties & 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.

Education, Requirements & Competencies

  • Bachelor's degree from four-year college or university
  • R.N. or J.D. preferred with 3-5 years’ experience in clinical nursing and/or 3-5 years claims experience dealing with serious bodily injury. 
  • 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.

 

Coverys is an equal-opportunity employer. Coverys’ job openings are open to all without regard to race, color, national origin, gender, gender identity, religion, age, height, weight, disability, political beliefs, sexual orientation, marital status, family status, or veteran status.