Claims Consultant Job Description

Claims Consultant Job Description

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148 votes for Claims Consultant
Claims consultant provides office of Legal Affairs and Georgia Tech Contract Officers with direction on appropriate insurance provisions for various Institute contracts and agreements.

Claims Consultant Duties & Responsibilities

To write an effective claims consultant job description, begin by listing detailed duties, responsibilities and expectations. We have included claims consultant job description templates that you can modify and use.

Sample responsibilities for this position include:

Be a visible sign of professionalism and direction for the practice
Responsible for the assessment, management and administration of a portfolio of 90 risk product claims with authority to determine benefits up to $100,000 for lump sum claims and $4,000 per month for temporary disablement claims without management referral
Identify and action pay and finalise opportunities
Identify commutations and settlement opportunities and action these as per the protocols
Ensure intervention points are set and that file reviews are appropriately identified for senior action
Effectively and pro-actively communicate with internal stakeholders
Effectively and pro-actively communicate with clients, advisers and brokers and adhere
Assist with the training of newer assessors
Effectively manage complaints via CR, FOS, SCT and other bodies
Assist with the management of litigated matters

Claims Consultant Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Claims Consultant

List any licenses or certifications required by the position: CII, PMP, CCP, CBAP, CEE, ARM, CPCU, SCLA, CCLA, CPC

Education for Claims Consultant

Typically a job would require a certain level of education.

Employers hiring for the claims consultant job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Business, Technical, Management, General Management, Interpretation, Education, Computer Science, Law, Finance, Associates

Skills for Claims Consultant

Desired skills for claims consultant include:

Laws
Legal codes
Procedures and processes involving insurance
Contracts and their provisions
Policy provisions and coverages associated with liability claims
Word and Excel
Microsoft Office
Our business and products
Positive engagement with our customers
Skill to effectively develop long term partnerships that meet client expectations and needs

Desired experience for claims consultant includes:

Previous operational experience in healthcare
Broker’s license (NJ Producer) within 1 year of obtaining this position
Provides analysis to major projects and improvement efforts
Provide support to the team as required
Request medical, financial evidence (including surveillance or interviews with claims assessors) – can maybe update this to "ensure claims are actively managed by ensuring appropriate investigations are made such as medical, financial and factual"
Admit claims and calculate benefits

Claims Consultant Examples

1

Claims Consultant Job Description

Job Description Example
Our company is growing rapidly and is hiring for a claims consultant. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for claims consultant
  • Seek to amicably resolve questions on particular claims decisions (including decisions to deny claims) and provide satisfactory explanations
  • Draft responses to written enquiries from complaint bodies – FICS, SCT
  • Conduct fact finding interviews
  • Instruct external suppliers of information eg medical advisers, claims assessors and surveillance operations in company requirements
  • Authorise claim payments, premium refund or waiver and claim back from reinsurers
  • Provide technical advice as required
  • Training and coaching of Junior Claims Assessors
  • Participate in self/team development activities
  • Actively work at increasing quality, service and cost efficiency
  • Direct credit claim payments
Qualifications for claims consultant
  • Working knowledge of CAS or MetaVance
  • Play an active role in departmental projects as directed by Team Leader
  • Assisting with reporting/external and internal audits where required
  • Manage day to day activities of up to two Claims Associates
  • Associates Degree or higher, or relevant industry experience
  • Claims processing knowledge and understanding
2

Claims Consultant Job Description

Job Description Example
Our company is growing rapidly and is looking for a claims consultant. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for claims consultant
  • Work closely with the Claims Operations team to ensure that claims policy is appropriately embedded and ongoing understanding of gaps and areas for improvement in policy
  • Support the delivery of training and education programs through the policy training team and L&D team
  • Ability to structure the work of and manage teams of 2-4 consultants
  • Ensuring accuracy and robustness of analyses and ensuring quality of overall delivery, providing comprehensive support to Principals and Partners in project execution
  • A key part of the position includes managing the client relationship and being the primary contact point for senior client executives
  • Client management activities include leading meetings and presentations and interfacing with clients on a day to day basis
  • Evaluate complex claims to determine potential liability, formulate resolution plans and proposals and establish initial and/or additional reserves within assigned authority level and excess of authority levels with management approval
  • Reviews applicable policy language and determines coverage based upon the facts of the claim, policy language and relevant case law
  • Performs an independent analysis of counsels recommendations and challenges counsel's proposed strategy, if appropriate
  • Manages activities of vendors including attorneys and consultants
Qualifications for claims consultant
  • Medical claims coding certification
  • Claims processing or medical subrogation
  • Query writing (SQL preferred)
  • Background in claims processing on CAS and or MTV
  • Proven performer with strong technical knowledge and work experience adjusting or managing workers’ compensation claims or possess multi-line claims experience with emphasis on casualty lines of coverage
  • Multi State and/or Colorado State Worker’s Compensation experience and knowledge
3

Claims Consultant Job Description

Job Description Example
Our growing company is hiring for a claims consultant. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for claims consultant
  • Provide written and verbal reports to management
  • Effectively work as a ClaimsXten rules development subject matter expert on client implementations
  • Effectively participate on internal or external ClaimsXten Service Delivery Team meetings and initiatives
  • Ensure consistency in improving foundational business practices both within a specific function and cross-functionally
  • Drive efforts to support business unit initiatives, providing Health & Dental expertise
  • Working key external business partners to research and implement key product and legislative changes
  • Analyzes and processes more complex claims by investigating, gathering and obtaining information to make claim determinations
  • Collaborates with appropriate internal stakeholders to determine claim eligibility
  • Conducts interviews with external stakeholders
  • Evaluates and makes recommendations regarding more complex claim eligibility determinations to management
Qualifications for claims consultant
  • Experience coordinating multiple projects in a deadline-driven environment
  • Demonstrated experience in claims management and process
  • Extensive technical experience in claims management demonstrated through previous technical and/or senior claims assessing roles
  • Extensive experience in strategically assessing claims under Risk Insurance and/or Corporate Superannuation
  • Exceptional and expert knowledge of Retail and/or Corporate Superannuation insurance products
  • Prior SQL database development
4

Claims Consultant Job Description

Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of claims consultant. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for claims consultant
  • Negotiates settlement of more complex claims up to designated authority level and makes claims payments
  • Partners with junior team members on more complex claim reviews and determinations
  • Partners with Business Analysts to identify requirements in support of strategic projects
  • Managing an assigned client portfolio
  • Transactional processing, following up and securing reinsurance recoveries, collateral and timely and accurate system entry of all assigned client activity
  • Assessing and submitting client and/or reinsurer presentation materials and communications to resolve questions and secure reinsurer agreement and payment of claims balances
  • Coordinating and attending reinsurance audit/reviews with client and reinsurer
  • Review open claims and/or premium activity, reconcile records, and facilitate review/audit
  • Providing detailed information on claims process for Request for Proposal (RFP) and sales opportunities
  • Promoting, building and maintaining relationships with Brokers, Clients and Markets
Qualifications for claims consultant
  • Strong MS Office skills a must
  • Excellent time management skills organization skills
  • Minimum of 5-10 years of industry Commercial claims experience
  • Experience in the area of Workers Compensation (WC) statutes is a must
  • Experience within the construction industry is preferred but not required
  • Experience with General Contractor and Construction Managers preferred but not required
5

Claims Consultant Job Description

Job Description Example
Our growing company is looking to fill the role of claims consultant. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for claims consultant
  • Ability to interact professionally with all internal and external customers, including peers, members of management, members of other business areas/segments, attorneys
  • Conduct performance analysis to recommend learning approach to close performance gaps
  • Consult with L&D colleagues, managers and other subject matter experts to create learning programs
  • Understand claim handling environment of assigned client group (product enhancements, best practices, compliance and legal issues) and respond with learning interventions that support effective claim handling
  • Implement Claim operations solutions to meet regulatory requirements
  • Lead Claim Operations market conduct or financial exam activity, corrective action plans responses and restitution projects
  • Collaborating with our field operations teams and analytics teams to define goals, key performance indicators, implementation plans, and communicate the progress of your results
  • Prioritize opportunities and gain alignment on what the claims product team will do (and won’t do) to achieve specific objectives
  • Design and implement technology changes and vendor solutions to make the claims adjusting work simpler, more engaging, and more accurate
  • Map and communicate the current and future state of our claims process to key stakeholders within the No Fault organization, our senior leadership team, US and global consumer markets, and key partnering organizations like the Customer Advocacy Office
Qualifications for claims consultant
  • DBA experience in direct handling or oversight required
  • Strong and proven ability to influence others and produce positive outcomes
  • 5-10 years relevant professional experience working in or consulting to the P&C insurance industry
  • At least 3 years’ experience in handling and managing multiple P&C claim types (auto, property, casualty)
  • Candidates must be comfortable presenting to senior executives and high level client audiences
  • Ability to work in a team environment, ideally in a project based structure

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