Evaluation Sr Consultant - Remote

Job Summary:

This job is responsible for supporting management in ensuring consistency and objectivity in the Market Claim Office (MCO) by conducting ongoing, quality investigations of coverage, liability and damages through communicating with adjusters and defense counsel to review the claim file and determine claim value. This individual takes a second look at the claim evaluation process and provides a recommendation on injury and claim value. Also, monitors trial activity and assists in developing complex litigation strategy. The individual also ensures compliance with the claim process, identifies drivers of quality on operational results, and consults with adjusters and management on proper procedures, trends, file quality, negotiation strategies, and value drivers.

Key Responsibilities:

• Manages, researches, and resolves complex and occasionally highly complex customer communications, concerns, conflicts or issues

• Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision-making process

• Performs open and closed claim audits of complex and occasionally highly complex files

• Reviews system reports to identify trends or issues and selects file for review based on trends and reports

• Analyzes and evaluates complex and occasionally highly complex claim processes or procedures and explains information and analysis as a result of the research

• Leads or facilitates formal claim training, coaching, mentoring and feedback on casualty claim adjusting

• Acts as a resource to MCO on complex and occasionally highly complex claim or coverage matters and high severity claims

• Researches, responds to or participates in Department of Insurance complaints or investigations and processes

• Participates in or leads Telephone Alert Conferences regarding complex claims referred to Home Office

Education and Experience:

• 3 or more years of Casualty experience

• Complex Claims Handing experience (preferred)

• UM / UIM Claims Handing experience (preferred)

• NY and/or NJ Claims Handing experience (preferred)

• Bachelors Degree (preferred)

Functional Skills:

• Applies advanced knowledge of insurance policy, coverage, and regulation

• Applies advanced knowledge of claim processes, policies, procedures, claim systems, coverage, liability, damage estimating, and/or settlement, and adherence to applicable legal compliance standards

• Advanced knowledge of analytical procedures to reconcile, manipulate, and recognize patterns of data

• Applies advanced knowledge of problem solving and preparation of complex reports for analysis

• Applies advanced knowledge of training facilitation and coaching skills

Notes:

The preceding description is not designed to be a complete list of all duties and responsibilities. May be required to perform other related duties as assigned. Regular, predictable attendance is an essential function of this job.

This position is not available for Puerto Rico, California, Alaska, and Hawaii residents.