Employee type: 

Full-Time

Job type: 

Insurance

Industry: 

Healthcare - Health Services

Manage others: 

No

Travel: 

Minimal

Claims Consultant

The Claims Consultant works under the general supervision of the Director of Risk Strategy and is responsible for the overall management of claims incurred by the insurance book of business. Incumbent, in a prompt and thorough manner must guide claims from inception through closure. The Claims Consultant works with clients to assure the carrier and the employer handle claims appropriately. This position will work with the Loss Control Consultants, Account Managers (AM), and the Commercial Lines team to assist clients in minimizing losses and mitigating claims to reduce their ultimate costs.

What you can look forward to;

Client Advocacy

  • Review all open claims reserved for $25,000 and above in the WG book of business and identify those that require active management.
  • Develop strategies for managing claims to ensure timely closure, resulting in the most optimal outcome for the client.
  • Schedule claims and lead claim reviews for specified employers.
  • Work with carriers, third party administrators and policyholders to implement strategies.

Support of Sales Process

  • Assist Sales Department on new and renewal sales as defined within the department’s service plan or as assigned.
  • Coordinate written service agreements with Loss Control Consultants, and sales team.
  • Use reports generated by the AMS examine and determine all relevant information that directly effects your area’s (or individual) expertise and respond appropriately.

Reporting

  • Provide monthly status report to Director of Risk Strategy on all claims under current management.
  • Input all notes (according the company’s stated business rules) of customer/member interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.

Requirements: 

  • BS/BA and two plus years’ experience working in a similar position or seven years equivalent work experience.
  • Demonstrated knowledge of Claims Management Procedures/Protocols, Medical Terminology and Medical Case Management
  • Experience in handing claims under multiple lines of coverage (workers comp, GL, EPL, D&O, etc.) preferred.
  • Understanding of the business needs of WG clients/members
  • Ability to evaluate carrier/TPA conduct and implement special account instructions
  • Knowledge of Microsoft software programs required.
  • Strong written and verbal communication skills including the capability to develop high quality output documents.
  • Bilingual in English and Spanish preferred.
  • Ability to work independently efficiently, and effectively in a multi- project, multi-demanding environment.
  • High level of organization and attention to detail.
  • Proficient ability to use a multi-channel contact center software (e.g. customer/associate management systems).
  • Verifiable, clean DMV record and the ability to travel to various locations throughout the U.S. (mainly throughout California) up to 10%

Send resume to Lola da Silva, ldasilva@WGA.COM 

 

 

Thank you for your interest in employment with Western Growers. At this time, we are not accepting any third-party vendors.

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