Claims Consultant

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

civil litigation

Our home office is located in vibrant Columbia, Missouri - #6 in Livability's 2019 Best Places to Live.

Other details

Pay Type Salary

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