Senior Investigative Claims Consultant

Worcester, MA | Full Time

Post Date: 06/05/2017 Job ID: JB661 Industry: Other

Summary

Performs independent audits of claim personnel as directed by management. Resolves complex claims using service oriented file handling. Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis. Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.

Responsibilities:

  • Experienced in many areas of claim handling, including, but not limited to, SIU, investigation, litigation and financial reviews.
  • Maintains thorough understanding of the claims handling and settlement processes and procedures and manages in line with our claim philosophy in accordance with policy provisions and state and federal law.
  • Independent ability to gather and review data from different resources and make and/or direct responsible decisions.
  • Thoroughly investigate all assigned claims by formulating an action plan, implementing action items, ordering and objectively evaluating data and thoroughly utilizing resources appropriately.
  • Works independently to develop appropriate files for settlement and conducts settlement independently, traveling as necessary to meet and/or negotiate with claimants or legal representatives with management approval..
  • Subject matter expert with deepest technical expertise/experience within the unit and serves as an expert witness (30b6).

Requirements:

  • A minimum of 5-10 years of claim, SIU or industry experience required
  • A minimum of five years of disability claims experience preferred.
  • Must be proficient Proficient in Word/Excel/Access
  • Exceptional knowledge of claim processes, procedures and state & federal laws.
  • Outstanding knowledge of Disability insurance required.
  • Ability to travel frequently - averaging around up to 12 times per year with some overnight travel required.
  • Strong leadership and mentoring skills.
  • Outstanding decision making, verbal/written communication and attention to detail required.
  • Achievement of professional designations (CLU, ALHC, CFE, FLMI, CPA, MSW, DSN, HIAA and DIA) strongly encouraged

 


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