Claims Consultant
3 weeks ago
Monday, April 22, 2024
Are you driven to keep people safe? That’s what we do every day at Missouri Employers Mutual.
We’ve created a casual, values-driven work culture that’s making a positive impact on the way people live and work. This is a place where you can grow with confidence — because that’s what safety and success really mean to us.
ABOUT THE COMPANY
At MEM, we’ve created a casual, values-driven work culture that’s 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
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