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Years of Experience
Date Last Verified
ProfileClaims Consultant - Excess & Surplus / Specialty Duties: Acts as a subject matter expert in a particular line of business or risk. Responsible for organizational oversight of claim files, delivers timely, meaningful and effective consultative advice, and contributes to the Claims Division attainment of High Quality Claim Outcomes. Responsible for the review and approval of coverage letters to ensure the consistency and accuracy of coverage positions asserted by the Claims Division. Performs Operational Technical Role working with claims divisional managers and directors to develop training plans and strategies for Claim Division. Identifies, evaluates and communicates trending observations and recommendations concerning risks, opportunities and emerging issues (industry, legal and regulatory) relevant to the Claims/Underwriting Divisions. Performs oversight of claim files and delivers timely, meaningful and effective consultative advice to excess and surplus lines Claims Division. Reviews and Approves coverage letters to ensure the consistency and accuracy of coverage positions asserted by the Claims Division. Responsible for timely, meaningful and effective consultative advice to Claim Professionals relative to Coverage, Investigation, Evaluation and Negotiation to contribute to the Claims Division attainment of high quality claim resolution by providing knowledge transfer and sharing through file oversight by way of strategic tactical advice to Minimize/Manage Risks; Maximize/Leverage Opportunities and Identify Emerging Issues. Provides specialized consultation with Claim Professionals to ensure proper selection of coverage counsel. This includes personal follow up with coverage counsel as to the scope of assignment, including whether opinion is verbal or written. Functions as a LOB content expert to assist with the Design and Facilitation of technical training needs as identified. Identifies technical training needs and develops action plans to meet those needs as required. May provide technical consultation/direction to all levels of claim professionals. Functions as a content expert to assist in developing training curricula. Assists in New Product Development and Technical Advice with Internal Business Partners. Identifies, evaluates and communicates trending observations and recommendations concerning risks opportunities and emerging issues (industry, legal and regulatory) relevant to the Claims/Underwriting Divisions. Designs specific Reservation Of Rights templates for use by technical associates across channels. Approves all Reservation Of Rights, disclaimers, tender/rejection/acceptance letters. Assists in new product development and management. Provides claims handling expertise to new product development. Provides standardized processes for claims handling related to new products. Liaisons with Reinsurance auditors to research and answer questions on specific claims. Monitors litigation trends and handling practices to ensure that lawsuits are handled in a consistent fashion. Provide technical consultation/direction to complex claims which require the highest level of technical skill and expertise. Maintains current knowledge of: multiple coverage lines; venue specific court decisions which may impact the claims function; current guidelines in the claims function; and policy changes and modifications. May require attendance at various seminars and training sessions. Performs other related duties as assigned.
Qualification and Experience
REQUIREMENTS: Advanced degree preferred. Licensed attorney with coverage litigation experience in either first or third party litigation a plus. Completion of insurance courses such as IIA, AEI, or CPCU a plus. 10 years prior insurance experience required. Proven experience handling and/or managing higher severity and/or complex claims and litigation required. Proven experience analyzing and handling complex coverage issues. Specific experience in a particular line of business may be required by the hiring business unit. Special knowledge in a particular line of business and/or additional education may be required by the hiring business unit. Must be effective in oral and written communication while interacting with other insurance and legal professionals. This includes the ability to maintain open and trusting working relationships while teaching, coaching and mentoring other professionals in a compassionate and empathetic manner. Has the ability to effectively manage conflict and practices attentive and active listening.
Job ID: 48558