claims consultant

The Hartford

<div>Consultant Claims - CH08CE<p>
We&rsquo;re determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals &ndash; and to help others accomplish theirs, too. Join our team as we help shape the future.<br>
</p><p></p><p>This is a visible and important role within the Hartford Global Specialty (HGS) Claims Division. As a Claim Consultant, you will be responsible for handling a caseload of general liability bodily injury and property damage claims from inception to final disposition. These claims will involve both primary and excess coverages and often involve complex fact patterns requiring analysis of contracts between parties to determine indemnity and contribution obligations and risk transfer opportunities.</p><div><div><div><div><p><b>
Responsibilities include, but are not limited, to:</b></p><ul><li><p>
Conducting investigations and analyzing and evaluating the information learned</p></li><li><p>
Making coverage determinations and communicating written position(s) to insureds and other required parties</p></li><li><p>
Within prescribed authority levels, setting appropriate expense and indemnity reserves and monitoring on a regular basis for any needed adjustment</p></li><li><p>
Presenting cases to management for expense and indemnity reserve authority above established authority levels</p></li><li><p>
Developing and implementing resolution strategies to achieve high quality outcomes</p></li><li><p>
Proactively managing litigation and counsel, inclusive of litigation planning and execution, budgeting and bill review</p></li><li><p>
Attending trials and mediations as necessary</p></li><li><p>
Contributing to broader claim and enterprise goals by participating in audits, projects and product development initiatives</p></li><li><p>
Preparing comprehensive reports and delivering presentations to senior claim leadership on case developments, policy issues, industry trends, etc.</p></li><li><p>
Working with business partners to evaluate and address claim trends and developments</p></li><li><p>
Addressing inquiries from agents and policyholders and providing superior customer service</p></li></ul><p><b>
Requirements:</b></p><ul><li><p>
Bachelor&rsquo;s degree preferred; law degree a plus</p></li><li><p>
Minimum of five years handling General Liability litigated coverage and liability matters</p></li><li><p>
High level of discipline; results-oriented; and able to focus on bottom line results</p></li><li><p>
Superior analytical ability and organizational skills</p></li><li><p>
Excellent oral and written communication skills</p></li><li><p>
Excellent strategic thinking ability and execution skills</p></li><li><p>
Excellent negotiation and advanced technical claim handling skills, including knowledge of coverage and tort laws</p></li><li><p>
Full command of issues and medicals relative to high value bodily injury claims</p></li><li><p>
Strong ability to analyze coverage and liability issues, manage time limit demands and assess extra contractual exposures and other issues of complexity</p></li><li><p>
Ability to communicate thoughts clearly and concisely, and to influence and persuade others</p></li><li><p>
Superior interpersonal skills</p></li><li><p>
Ability to exceed expectations and influence others to do the same</p></li></ul><p>
This role can have a Hybrid or Remote work arrangement. Candidates who live near one of our office locations (Hartford, CT, San Antonio, TX, Lake Mary, FL, Phoenix, AZ, Naperville, IL, Alpharetta, GA) will have the expectation of working in an office 3 days a week (Tuesday through Thursday). Candidates who do not live near an office will have a remote work arrangement, with the expectation of coming into an office as business needs arise.</p></div></div></div></div><p><b>
Compensation</b></p><p>
The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford&rsquo;s total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:</p>
$84,800 - $127,200<p>
Equal Opportunity Employer/Sex/Race/Color/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age</p></div>

General Liability Claims Consultant

Crane Agency

<div><div><b>Are you a Workers&rsquo; Compensation/Property Claims Consultant passionate about providing extraordinary service to your clients? Do you want to work for a family-friendly organization that cares about and invests in YOU, promotes a culture of flexibility, provides a life/work balance, and offers a competitive salary and benefits package? If you answered yes to any of these questions, then Crane is an excellent fit for you.
</b></div>
<div></div><div>Here&rsquo;s an overview of what you&rsquo;ll be doing in your exciting, new career as a Claims Consultant:</div>
<ul><li>Conduct client presentations on risk management and claims topics in conjunction with Crane producer units.</li>
<li>Work directly with clients to help educate and assist them with establishing claims reporting procedures, drug testing, background checks, medical cost control, employee handbooks, and the preparation of proper job descriptions.</li>
<li>Inquire on individual claims identified by the broker or the account. Evaluate for appropriate handling and reserving value.</li>
<li>Act as the insured's advocate in coverage disputes with the insurance company.</li>
<li>Analyze trends after obtaining and monitoring loss information from insurance carriers.</li>
<li>Conduct phone inquiries regarding open claims with insurance adjusters.</li>
<li>Prepare claim status reports with visual documentation including Excel graphs and provide the information to clients.</li>
<li>Assist insureds with return-to-work programs for injured workers including light duty, modified duty, and charity placement by coordinating with occupational medicine providers.</li>
<li>Maintain relationships with carrier partners and occupational medicine providers.</li>
<li>Prepare cost benefit analysis for agency management personnel.</li>
<li>Schedule work activities and monitor necessary target completion dates and required deadlines.</li>
<li>Organize and assist in facilitating client seminars.</li>
<li>Work in numerous online carrier claim systems.</li>
<li>Input all required documentation into agency management system.</li>
</ul>
<div></div><div><b>Qualified candidates must have complete knowledge of Property, Liability, and Work Comp claims. Comprehensive expertise of insurance practices and procedures in the industry is a must. Intermediate to Advanced knowledge of Microsoft Office is a must. Knowledge of the EPIC agency management system and an Associate in Claims (AIC) professional designation is a plus!</b></div>
<div>Candidates must be customer focused and possess a friendly, positive attitude with a willingness to help others. Excellent prioritization, verbal and written communication, professional telephone manner, attention to detail, and follow up is required. Candidates must contain effective problem-solving techniques with the ability to multi-task in a fast-paced environment.</div>
<div></div><div><b>About us:</b> At Crane, we understand the needs of our clients because our organization was built by business owners and families just like you. We help our clients prepare for uncertainty by providing the types of insurance products needed to meet your business and personal needs. We also offer a wealth of value-added resources including Risk Management, Claims Consulting, Bonds, and Employee Benefits Consulting. Crane has over 265 employees who are driven to be the best in our industry. Through innovation and technology, we strive daily to exceed customer expectations with service that is responsive and reliable. We value long term relationships with our clients, our employees, and the communities we serve. Founded in 1885, Crane has witnessed the turning of two centuries and continues to thrive today by helping protect what matters most. To find out more about Crane Agency, please visit our website at www.craneagency.com.</div></div>

Commercial Lines Claims Consultant

AAA Life Insurance Company

<div>
 <strong>
  Overview
  <br/>
  <br/>
 </strong>
 AAA Life is a respected and trusted American brand that has been focusing on Life Insurance and Annuity Products since 1969. At AAA Life we have over 1.8 million policies where we take pride in earning the trust of our policyholders who understand our promise to be there for them &ndash; and their families &ndash; when we&rsquo;re needed most. By joining the AAA Life team, you are joining a company that genuinely cares about helping each other, with a devotion to protect the lives of those around us. We embrace a diverse, equitable, inclusive culture where all associates can feel a sense of belonging and use their unique talents and perspective to influence, innovate, motivate, and thrive.
 <br/>
 <br/>
 The Medical Claims Consultant is responsible for providing medical and business expertise and knowledge in support of claims decisions. This role&rsquo;s primary responsibility is to serve as a resource to the claims team including contestable claims examiners, Accident and Health examiners, claims consultants and management with respect to denials, appeals, escalations or complex medical questions that arise in the processing of claims.
 <br/>
 <br/>
 <strong>
  Responsibilities
  <br/>
  <br/>
 </strong>
 <strong>
  How You&rsquo;ll Work
  <br/>
  <br/>
 </strong>
 Work Solution: Hybrid
 <br/>
 <br/>
 Relocation Eligibility: Not Available
 <br/>
 <br/>
 <ul>
  <li>
   Serve as a resource to the contestable claims team. This includes review of contestable claims as needed by claims personnel.
  </li>
  <li>
   Review of medical documentation including physician and hospital records, accident reports or other clinical materials
  </li>
  <li>
   Review and understanding of policy language &ndash; interpret policy exclusions and endorsements in relation to medical findings
  </li>
  <li>
   Review all contestable claim denials, including those that may have potential to result in litigation
  </li>
  <li>
   Identify inconsistencies or gaps in medical documentation and recommend additional information when needed.
  </li>
  <li>
   Serve as a resource to claims consultants and management with regards to denials, appeals or escalations that involve medical decisions
  </li>
  <li>
   Resource to the entire claims team with respect to complex medical decisions that arise in the day-to-day handling of claims. Assist in determining whether a claim is eligible under policy language and with respect to any supporting medical documentation.
  </li>
  <li>
   Provide training for claims examiners on medical topics relevant to claims decision making
  </li>
  <li>
   Support claim work related to denials or appeals that require medical decision making
  </li>
  <li>
   Participate in training and round tables, providing medical expertise in support of claims decision making.
  </li>
  <li>
   Collaborates closely with claims examiners, underwriters, legal counsel and potentially third parties to ensure accurate and fair claims decisions
  </li>
  <li>
   Maintain up-to-date knowledge of relevant medical standards, diagnostic/treatment guidelines, and regulatory/industry developments that impact claim adjudication
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Qualifications
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Doctorate or Advanced healthcare degree (MD, DO, BA-PA (Physician Assistant Bachelor&rsquo;s Degree in conjunction with PA certification, PA-C, NP, RN) with demonstrated claim-consulting or clinical review experience
  </li>
  <li>
   Clinical experience (min 5-10 years) with a strong familiarity of a broad range of medical conditions, treatments or outcomes
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred Qualifications
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Experience in the life insurance industry
  </li>
  <li>
   Excellent ability to interpret and synthesize complex medical records, and to translate findings into actionable claims decisions.
   <br/>
   <br/>
  </li>
 </ul>
 While performing the duties of this job, the employee is frequently required to stand, walk, sit, use hands to finger, handle, or feel, talk, hear and concentrate. Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus.
 <br/>
 <br/>
 This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodation will be made for otherwise qualified applicants as needed to enable them to fulfill these requirements.
 <br/>
 <br/>
 We are committed to ensuring equal employment opportunities for all job applicants and employees. Employment decisions are based upon job-related reasons regardless of an applicant's race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, marital status, genetic information, protected veteran status, or any other status protected by law.
 <br/>
 <br/>
 <strong>
  AAA Life Insurance Company does not offer immigration sponsorship for this position. This includes visa types such as H-1B, TN, and STEM OPT. Please do not apply if you currently require or may require employer-sponsored immigration support now or in the future.
  <br/>
  <br/>
 </strong>
 PM21
 <br/>
 <br/>
</div>


Medical Claims Consultant- Part Time

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