Claim Consultant - Medical Professional Liability

Coverys, Inc.; Northern (KY); Hybrid; USD 88,000 - 119,000; Full time

Job summary

Coverys seeks a skilled claims professional to interview insureds, claimants, and witnesses to assess liability exposure. You will document investigations, prepare reports, and secure records while coordinating with internal teams to support timely action on complex cases.

The role requires a Bachelor's degree, knowledge of medical/legal/insurance terminology, strong communication, and 25–30% travel. RN or JD with 3–5 years' related experience is preferred.

Qualifications

• Bachelor's degree from four-year college or university.
• RN or JD 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.
• Ability to travel 25-30% required.

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.

Skills

Communication

Data synthesis

Workflow design

Data research

Education

Bachelor's degree from four-year college or university

RN or JD preferred with 3-5 years' experience in clinical nursing and/or 3-5 years claims experience

Job description

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.
• Ability to travel 25-30% required.

The salary range for this role is $87,500 - $118,500. Individual compensation packages are based on a variety of factors that are unique to each candidate including location, skill set, experience, qualifications and education.

If you're a caring and customer focused individual who enjoys working with passionate team members, Coverys is the right company for you! They say an organization is only as good as its people. Here at Coverys, we believe that our employees are our most valuable asset. Each of our positions is thoughtfully crafted to ensure alignment with our mission, and every opportunity to join our team is an opportunity to support and protect the healthcare community. Our open positions offer you the chance to join a team of compassionate, dedicated, and resilient employees who are committed to becoming the best in the business. We are an organization committed to growth and professional development, keeping up to date with changes in the healthcare industry to ensure we're providing our insureds with the best possible support. All the while, we are committed to our employees and listen to the needs of our internal talent. Our benefits package is available day 1 of employment, so you never miss a beat. There is truly something for everyone in our benefits package, whether you are raising a family or a furry friend, or you're an avid traveler who uses PTO to chase down your next adventure. The important work done by Coverys employees is not limited to what's done at our desks. Throughout the year, we provide ample opportunities to get involved in our local communities. We get involved, we raise money, and we give back. Connecting with colleagues takes on new meaning when you're elbow-deep planting trees or rolling up your sleeves serving lunch to those in need. The giving doesn't end there - Coverys cares about the initiatives near and dear to your heart. That's why we offer directed donations, as well as company matchings, to support the organizations that you are personally involved with. Coverys is a dynamic organization, with opportunities to join our team across the US, as well as internationally in the UK and Ireland.

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.