Corporate Claims Consultant

Old Republic Commercial Risk; Baltimore (MD); On-site; USD 120,000 - 160,000; Full time

Job summary

Old Republic Commercial Risk seeks a senior claims director to provide technical direction to a claims staff handling complex cases. You will oversee reserve and settlement decisions, ensure QA adherence, and help shape corporate policies and procedures.

You will lead training initiatives, assess staff development needs, and coordinate with TPAs and PMAIC field claims while upholding the company's Code of Business Conduct and Ethics.

Qualifications

• Bachelor's degree or 5+ years of equivalent experience in insurance required.
• Extensive knowledge of insurance contracts and adjusting techniques; familiarity with medical terminology.
• Demonstrated leadership, coaching, and teamwork skills.
• Advanced skills in applying sound judgment/analysis, decision making/problem solving, planning and organization and negotiation.
• Demonstrated customer service and collaboration skills.
• Excellent verbal and written communication skills.
• Computer literacy including MS Office (Word, Excel, PowerPoint).
• Previous supervisory experience; CPCU or AIC desired.

Responsibilities

• Provide technical oversight for unbundled claims assigned to TPA partners inclusive of reserve and settlement authority in excess of TPA discretionary limits.
• Provide overflow support to bundled claims handled by PMAIC field claims inclusive of reserve and settlement authority in excess of field authority.
• Direct handle an assigned pending of corporately established liability files.
• Provide support to various compliance related activities relative to TPAs.
• Support Quality Assurance processes to assess quality of work product, identify improvement opportunities and foster discussions focused on solutions to enhance results.
• Develops, communicates and ensures compliance with corporate policies and procedures; leads project teams focused on resolving corporate claims issues.
• Assesses staff training needs and conducts training focused on improving performance.
• Demonstrate commitment to Company’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities.

Skills

Leadership

Coaching

Teamwork

Communication

Problem solving

Negotiation

Customer service

Training

Compliance knowledge

Education

Bachelor's degree or equivalent

Tools

MS Office

Job description

Provides the highest level of technical direction to the claims staff to ensure appropriate outcomes for claims of the most complex nature. Executes quality assurance programs to evaluate staff adherence to the claim handling standards. Develops and ensures compliance with corporate policies and procedures.

Responsibilities

• Provide technical oversight for unbundled claims assigned to TPA partners inclusive of reserve and settlement authority in excess of TPA discretionary authority limits.
• Provide overflow support to bundled claims handled by PMAIC field claims inclusive of reserve and settlement authority in excess of field authority
• Direct handle an assigned pending of corporately established liability files
• Provide support to various compliance related activities relative to TPA's
• Support Quality Assurance processes to assess quality of work product, identify improvement opportunities and foster discussions that are focused on solutions to enhance results.
• Develops, communicates and ensures compliance with corporate policies and procedures. Leads project teams focused on resolving corporate claims issues.
• Assesses staff training needs and conducts training focused on improving performance.
• Demonstrate commitment to Company’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.

Requirements

Qualifications

• Bachelor's' degree or 5 or more years of equivalent work experience in an insurance related industry required.
• Extensive knowledge of insurance contracts and adjusting techniques. Familiarity with medical terminology.
• Demonstrated leadership, coaching, and teamwork skills.
• Advanced skills in applying sound judgment/analysis, decision making/problem solving, planning and organization and negotiation.
• Demonstrated customer service and collaboration skills.
• Excellent verbal and written communication skills.
• Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint.
• Previous supervisory experience, Chartered Property Casualty Insurance (CPCU) and Associate in Claims (AIC), or similar professional designation, desired.