Claim Consultant

2 days ago

🗽 New York – Remote

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

🍂 Massachusetts – Remote

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

💵 $87.6k - $118.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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Coverys

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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.

Medical Professional Liability Insurance • Medical Malpractice Insurance • Risk Management • Continuing Medical Education • Cyber & Regulatory Coverage

501 - 1000 employees

Founded 2010

⚕️ Healthcare Insurance

💸 Finance

📋 Description

• The Claim Consultant provides 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. • This role will investigate and adjust claims with high levels of complexity and severity. • 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.

🎯 Requirements

• 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.