Claims Consultant

Mem Ins; Columbia Township (MO); Hybrid; USD 80,000 - 110,000; Full time

Job summary

MEM is seeking a Claims Consultant to oversee high-exposure and complex workers' compensation claims. You will conduct POA meetings, CARE reviews, and coach field staff to ensure strong case management, reserving, investigations, and settlements.

Collaboration with senior management ensures robust policies and procedures in the claims manual. Experience in commercial liability claims and a track record of leadership in claims consulting is required.

Qualifications

• Certifications in claims and subrogation preferred.
• AIC, SCLA, CSRP are advantageous.
• Licensed to adjust workers' compensation claims preferred.
• Extensive liability claims background is expected.

Responsibilities

• Promote leadership and technical development for field claim teams.
• Lead monthly Plan of Action meetings for high exposure claims (> $500,000).
• Provide coaching on workers' compensation coverage, causation, and litigation issues.
• Offer claim-handling recommendations and ensure proper communications.
• Conduct CARE reviews to monitor progress and trends in operations.
• Oversee complex claims reviews and reserve adequacy, actions, and factors.
• Investigate questionable or no-coverage claims and manage liabilities.
• Coordinate with coverage counsel to resolve complex claims and lawsuits.
• Provide oversight for Argonaut Insurance claims including reserves and CARE Reviews.
• Develop jurisdictional training for new states MEM operates in.

Skills

AIC

SCLA

CSRP

Claims license

Education

AIC (Associate in Claims)

SCLA (Senior Law Associate)

CSRP (Certified Subrogation Recovery Professional)

Claims Adjusting License

Job description

At MEM, we've created a casual, values-driven work culture that is making a positive impact on the way people live and work. We offer a hybrid work model,

with positions to accommodate the changing needs of today’s employees. Our team enjoys a variety of different work environments, which allows for more

flexibility, less time spent commuting, and greater ability to address personal and

family needs. This is a place where you can grow with confidence - because that's what safety and success really mean to us.

MEM is headquartered in Columbia, MO, and our virtual team serves our policyholders and partners from across the U.S.

JOB PURPOSE

The Claims Consultant role is responsible for the oversight of high exposure and complex workers compensation claims. This role conducts claim POA (plan of action) meetings in accordance with our implemented POA Program. Conduct CARE Reviews (Audits) to identify 'best practices', adverse trends and 'just-in-time' training needs. Based on the findings, provide coaching and mentoring of the field claim staff to ensure their continued technical and professional growth and development. Work closely with the Manager, Claims Consulting, and claim management to ensure MEM’s Claim Department provides strong case management direction on claims via appropriate reserving, investigations, evaluations, and settlement. Provide claim technical oversight and consultative services regarding questionable coverage cases. Investigate and manage Employers Liability claims and lawsuits. Work closely with senior claim management to ensure timely and appropriate policies, practices and procedures are written and placed in our claim manual.

LICENSES AND CERTIFICATIONS

AIC (Associate in Claims) preferred

SCLA (Senior Law Associate) preferred

CSRP (Certified Subrogation Recovery Professional) preferred

Claims Adjusting License-preferred

RESPONSIBILITIES

Promote leadership and technical development for the field claim technical and management personnel. Ensure that areas of development are identified and timely training and/or feedback is given to the appropriate parties. Participate as a member of the claims training team to help develop and facilitate training modules for the claim department.

Conduct monthly Plan of Action meetings/file reviews on high exposure claims that generally have exposure greater than $500,000. Provide corporate oversight with respect to reserve adequacy, appropriate plan of actions and other critical claims factors. Provide technical coaching and mentoring to the field claim operations staff regarding workers compensation coverage, compensability determination issues and litigation issues. Provide claim-handling recommendations to field claim staff members and, when necessary, ensure appropriate communication are sent to appropriate parties.

Conduct CARE reviews to maintain accountability of staff that monitors and supports operational progress toward favorable results. Provide ongoing feedback to field claim management and analysis of trends in branch operations.

Evaluate areas of opportunity for development and recommend plan of actions for changing behaviors/improving results. Submit written reports to the Manager, Claims Consulting.

Conduct thorough claim reviews and corporate oversight for claims with incurred values greater than $250,000. Provide corporate oversight with respect to reserve adequacy, appropriate plan of actions and other critical claims factors.

Investigate and manage questionable and potential "no coverage" claims.

Investigate and manage Employers Liability claims and lawsuits. Works closely with Manager, Claims Consultant and/or coverage counsel to resolve complex coverage claims and lawsuits.

Provide claims technical oversight of Argonaut Insurance claims. This may include reserve and settlement authority approvals, CARE Reviews, and special claim projects. Conduct research and develop and implement jurisdictional training for new states in which MEM expects to operate. Conduct Burn Rate Reviews on open, high exposure claims ($500,00 or more).

Validate new or existing complex test methods and procedures; identify issues and recommend improvements to contribute to further development.

Organize and prepare complex documents using a variety of applications for technology devices, such as standard office software. Also responsible for gathering and summarizing data for special reports.

Design own monthly schedule and, if necessary, assign work to others in order to speed up office workflow and ensure high-priority tasks get done.

EXPERIENCE

Ten plus years' related and progressively responsible experience with a solid commercial liability claims background. Prefer extensive experience managing