Claim Consultant

The Claim Consultant will be responsible for the territory of New York State, primarily upstate and Western NY.  The Claim Consultant works remotely from his/her home so location is open.

Essential Duties & Responsibilities

• Claims Consultant Interviews insureds, claimants, witnesses and other appropriate parties to obtain information used to assess liability exposure. 
• Claims Consultant Documents related files regarding results of investigation and negotiations. 
• Claims Consultant Prepares reports to file on established diary dates and other specific reports as needed to ensure timely file documentation and plan of action.
• Claims Consultant Secures records for investigation and evaluation of cases.
• Claims Consultant Determines and implements negotiation strategy and negotiates settlements within authority level.
• Claims Consultant Timely adjusts reserves within level of authority and makes reserve recommendations to Manager/Director for amounts over position authority level.
• Claims Consultant 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.
• Claims Consultant Interacts with other departments as necessary to help facilitate and coordinate services to our insured and client.
• Claims Consultant Evaluates cases for appropriate disposition and seeks authority for settlement from Manager/Director when settlement amount requests exceeds authority.
• Claims Consultant Directs and monitors activities of defense counsel in compliance with Case Management Guidelines. 
• Claims Consultant Monitors trials and attends pre-trial proceedings, mediations and arbitrations as necessary.
• Claims Consultant Identifies significant insured Risk Management or Underwriting issues and directs the information to appropriate department.
• Claims Consultant Communicates with insureds, claimants and witnesses; consults medical and other relevant records, varying methods of investigation according to type of claim.
• Claims Consultant Analyzes and verifies insurance coverage for claims brought against policyholders.
• Claims Consultant 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.