Claims Consultant

OneGroup; New York (NY); On-site; USD 66,000 - 109,000; Full time

Benefits offered by this job

11 paid holidays

Medical, Vision & Dental insurance

401K with generous match

Pension

Tuition Reimbursement

Job summary

OneGroup is seeking a seasoned Claims Consultant to serve as a client-facing technical advisor for complex commercial P&C claims, excluding Workers’ Compensation. You will provide claim strategy, coverage consultation, and executive-level guidance while partnering with clients, carriers, counsel, Producers, and risk management teams.

Responsibilities include leading high-severity claims, reviewing coverage language, and coordinating with carriers and counsel to ensure effective outcomes.

Qualifications

• Five or more years of progressively responsible commercial P&C claims experience.
• Demonstrated experience with complex commercial claims, coverage issues, reserves, litigation, and carrier escalation.
• Strong knowledge of Property, General Liability, Auto liability, and related P&C coverage forms.
• Strong judgment, analytical ability, negotiation, writing, and relationship-management skills.
• Experience with Applied Epic or other claims systems; proficiency with Microsoft 365.

Responsibilities

• Lead high-severity, complex, litigated claims and develop action plans and objectives.
• Review liability, reserves, settlement posture, and carrier handling.
• Analyze policy language, endorsements, exclusions, and denials; advocate for carrier review.
• Coordinate with carriers, TPAs, counsel, experts, vendors, and leadership.
• Identify subrogation, risk-transfer, and recovery opportunities where applicable.
• Serve as the claims advisor for assigned clients and lead large-loss reviews and executive presentations.
• Provide proactive updates explaining developments, implications, and next steps.
• Evaluate carrier and TPA performance and elevate unresolved issues.
• Contribute to renewal, placement, retention, and carrier-selection discussions.
• Review loss runs, reserves, and loss drivers; translate into recommendations.
• Partner with Risk Management Consultants to connect claim trends with risk mitigation.
• Support client needs and handoffs with Producers and account teams.
• Contribute to service standards, escalation procedures, and training.

Skills

Commercial P&C claims

Complex claims handling

Policy coverage knowledge

Negotiation & communication

Applied Epic experience

Education

Bachelor's degree in insurance/risk mgmt/related field

AIC/CPCU or equivalent designation

Tools

Applied Epic

Microsoft 365

Job description

Overview

OneGroup is a team of more than 200 insurance and risk management professionals who are ONE company acting as ONE team, with ONE focus and ONE mission: To serve each client as our ONE client.

OneGroup is one of the fastest growing independent insurance and risk management organizations in the northeast. With team members in 18 locations, OneGroup can provide best in class client resources while maintaining an entrepreneurial, friendly and fun environment. A subsidiary of Community Bank, NA (NYSE: CBU), OneGroup is headquartered in Syracuse, NY.

OneGroup’s company culture sets us apart from the rest. Our core values, what we call “The OneGroup Way” consists of the following:

• Knowledge Development- Professional growth but also understanding the company, workflow processes, and the right people to get the job done. Adopting a growth mindset in everything we do.
• Big Picture– How your individual contributions connect to the bigger things around us that can make a difference to the client. How do you utilize your talents and the attributes of those around you to create a unique solution for the client.
• Acknowledgement– Recognize others contributions, appreciate what others do and their strengths.
• Transparency– An environment that encourages open communication and feedback.
• Bigger Purpose – How do we become more than just an insurance company to our clients? We seek to enhance our client’s businesses, support their mission, and understand their challenges.

Responsibilities

The Claims Consultant is a client-facing technical advisor responsible for complex commercial Property & Casualty claims, excluding Workers’ Compensation. The role provides claim strategy, coverage consultation, client advocacy, carrier accountability, and executive-level guidance while partnering with clients, carriers, legal counsel, Producers, Account Executives, Risk Management Consultants, and other stakeholders.

Primary Lines of Coverage Commercial Property, General Liability, Commercial Auto, Inland Marine, Builders Risk, Professional Liability, Employment Practices Liability, Management Liability, Cyber, Crime and Fidelity, Umbrella and Excess, and other specialty P&C coverages.

Essential Duties and Responsibilities:

• Lead high-severity, complex, litigated, sensitive, or coverage-challenged claims and develop clear action plans, ownership, and resolution objectives.
• Review liability, financial exposure, reserves, settlement posture, litigation developments, and carrier handling.
• Analyze policy language, endorsements, exclusions, reservations of rights, coverage positions, and denials; advocate for appropriate carrier review and escalation.
• Coordinate with carriers, TPAs, counsel, experts, vendors, and internal leadership while maintaining clear boundaries between consultation, carrier authority, and legal advice.
• Identify subrogation, risk-transfer, tender, indemnification, and recovery opportunities when applicable.

Client Consultation and Carrier Accountability

• Serve as the claims advisor for assigned clients and lead large-loss reviews, stewardship and service plan discussions, and executive claim presentations.
• Provide proactive, practical updates that explain significant developments, business implications, client actions, and next steps.
• Evaluate carrier and TPA performance, address delays or service concerns, and elevate unresolved issues to appropriate leadership.
• Contribute claims insight to renewal, placement, retention, and carrier-selection discussions.

Claims Analytics and Team Leadership

• Review loss runs, reserves, claim duration, severity, closure activity, and recurring loss drivers; translate findings into practical recommendations.
• Partner with Risk Management Consultants to connect claim trends with loss-prevention and risk-mitigation opportunities.
• Partner with Producers, account service teams, and other stakeholders to support client needs, new business, retention, and effective handoffs.
• Contribute to service standards, escalation procedures, training, and continuous process improvement.

Documentation and Compliance

• Maintain accurate and timely claim documentation, diary dates, communications, advice, and next steps in Applied Epic and other approved systems.
• Protect confidential information and follow privacy, cybersecurity, documentation, escalation, and E&O-risk-management requirements.
• Immediately elevate suspected reporting errors, missed deadlines, incorrect advice, or other potential E&O issues.

Qualifications

• Five or more years of progressively responsible commercial P&C claims experience with a brokerage, carrier, TPA, independent adjusting firm, or comparable organization.
• Demonstrated experience with complex commercial claims, coverage issues, reserves, litigation, settlement considerations, and carrier escalation.
• Strong knowledge of commercial Property, General Liability, Auto Liability, and related P&C coverage forms and claim processes.
• Strong judgment, analytical ability, negotiation, writing, presentation, and relationship-management skills.
• Ability to communicate confidently with clients, carriers, adjusters, legal counsel, Producers, and leaders.
• Experience with Applied Epic or another agency or claims-management system preferred; proficiency with Microsoft 365 required.

Preferred Qualifications

• Associate or bachelor’s degree in insurance, risk management, business, finance, or a related discipline.
• AIC, ARM, CPCU, or comparable insurance designation.
• Property & Casualty producer and/or claims-adjuster licensing, based on role and jurisdiction.
• Experience supporting large or multi-location commercial clients and facilitating claim reviews, stewardship meetings, analytics, and executive presentations.

Core Competencies

• Strategic claims judgment
• Client advocacy
• Coverage analysis
• Negotiation and influence
• Carrier accountability
• Executive communication
• Analytical thinking
• Technical leadership
• Documentation discipline
• Cross-functional collaboration

Measures of Success

• Complex claims receive timely strategic oversight, clear ownership, and effective escalation.
• Clients receive proactive, understandable, and decision-useful guidance.
• Claim reviews and stewardship discussions produce documented recommendations and follow-up actions.
• Consulting time remains focused on complex advocacy, analysis, strategy, and client-facing work.
• Claim files are accurate, timely, complete, and support retention, risk mitigation, and client strategy.

Other Job Information

Compensation: Commensurate with experience plus potential for annual merit increase. In addition to your competitive salary, you will be rewarded benefits including: 11 paid holidays, paid vacation, Medical, Vision & Dental insurance, 401K with generous match, Pension, Tuition Reimbursement, Banking discounts and the list goes on!

Physical Requirements: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee may be required to stand, walk or sit. Use hands and fingers, handle or feel, reach with hands or arms, and speak and hear. The employee may occasionally be required to lift and or move up to 25 pounds. Specific vision abilities required by this job include close vision, and the ability to focus.

The Company is an Aff… All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, sexual orientation and gender identity), national origin, citizenship status, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state or local law.

The Company will make reasonable accommodations for qualified individuals with a disability. If you have a physical or mental impairment and would like to request an accommodation with respect to the application process, please contact the Human Resources Department.

Minimum

USD $66,000.00/Yr.

Maximum

USD $108,804.00/Yr.