Claims Consultant, Professional and Errors & Omissions
Territory: The location of this position is flexible and open to virtual and/or remote based applicants.
What you can Expect: This position will support the Behavioral Healthcare program(s) in Professional Lines. Additional duties include assisting manager with reporting requirements to program(s). Qualified candidates will possess excellent written communication skills, pay attention to detail and provide prompt and superior service to customers. The position can be in office, work from home or a hybrid.
The ideal candidate will have:
- 10+ years of professional lines claims handling experience; experience with medical malpractice, general liability, along with behavioral health care E&O claims is preferred.
- 8+ years of litigation experience
- IIA, AEI, or CPCU preferred
(For internal use only) Compensation grade: G4
Job Description SummaryThe Excess Surplus (E&S) Claims team handles some of the most unique and interesting insurance claims at Nationwide. Many have complicated risks and loss history, requiring us to be adaptable and resilient in our work to help customers. If you love a challenge and can apply outstanding organizational, investigative and communication skills to your work, we want to hear from you!
As a Claims Consultant, you'll primarily be responsible for investigating, evaluating and resolving commercial and professional lines claims and lawsuits of a more severe and complex nature, or from a specialty line or program of significant value to the organization. These claims files typically include litigation and complex coverage issues. In addition, you'll work with claims divisional managers and directors to develop training plans and strategies for the division. We'll count on you to coach, train and mentor individual team members. Building and maintaining positive relationships with general agency and internal business partners, major customers and key individuals is important, too.
Resolves claims and lawsuits of a more severe and complex nature, or from a specialty line or program of significant value to the organization. Acts as a subject matter authority in a particular line of business or risk.
Identifies technical training needs and develops action plans to meet those needs. May provide technical consultation/direction to all levels of claim professionals. Functions as a content specialist to assist in developing training curricula.
Builds and maintains open and trusting working relationships with general agents, producers and key internal business partners.
Evaluates claims, in a timely manner, to identify and manage reserves according to company standards and best reserving practices.
Maintains current knowledge of multiple coverage lines, venue-specific court decisions which may impact the claim function, current guidelines in the claims function and policy changes and modifications. This may require attending various seminars and training sessions.
Reviews and analyzes files to ensure adherence to Division guidelines and best claims handling practices. Reviews claims quality results to identify coverage trends and to ensure consistency in policy interpretation. Recommends training or other appropriate action.
Provides consultation/direction to complex claims requiring the highest level of technical skill and expertise.
Ensures appropriate attorney assignments, proper reserving, prompt and accurate reporting to reinsurance carriers, prompt and fair negotiations and adequate trial preparation, if necessary.
Monitors litigation trends and claim handling practices to ensure lawsuits are handled in a consistent fashion. Maintains trial log for each line of business.
May designs specific reservation of rights templates for use by technical associates across channels. Approves all reservations of rights, disclaimers, tender/rejection/acceptance letters.
Provides claims handling expertise to new product development. Provides standardized processes for claims handling related to new products.
May perform other responsibilities as assigned.
Reporting Relationships: Reports to Senior Claims Manager, Director.
Typical Skills and Experiences:
Education: Undergraduate education in insurance, business, management, or related fields. Advanced degree preferred. Additional education in a particular line of business may be required by the hiring business unit.
License/Certification/Designation: Associates must acquire the required federal and/or state licenses/registrations within the time period designated by the business unit. Additional licenses/registrations may be required when new products and services are implemented. If an associate fails or is unable to acquire required licenses/registrations within the designated time period, the associate will be ineligible to continue in the position.
Completion of insurance courses such as IIA, AEI, or CPCU preferred.
Experience: Eight or more years prior insurance experience preferred. Proven experience handling higher severity and/or complex claims and litigation required. Proven experience analyzing and handling complex coverage issues. Specific experience in a particular line of business may be required by the hiring business unit.
Knowledge, Abilities and Skills: Proven knowledge of the best claims practices used to resolve severe claims practices. Confirmed knowledge in a particular line of business and/or additional education may be required by the business unit. Proven analytical skills to make independent decisions and resolve conflict in application of coverage to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions Much be able to effectively communicate and interact with other claim professionals in a leadership capacity. This includes the ability to maintain open and trusting working relationships while teaching, coaching and mentoring other claim professionals in a conscientious and empathetic manner. Ability to build and maintain open and trusting working relationships with insureds in order to gather pertinent information. Has the ability to effectively manage conflict and practices active listening. Ability to work independently and deal with ambiguity. Ability to present to all levels of management.
Other criteria, including leadership skills, competencies and experiences may take precedence.
Staffing exceptions to the above must be approved by the hiring manager’s leader and HR Business Partner.
Values: Regularly and consistently demonstrates the Nationwide Values.
Overtime Eligibility: Not Eligible (exempt)
Working Conditions: Normal office environment. Travel as necessary.
ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.
We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. To learn more about the benefits we offer, click here.
Nationwide is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. Nationwide prohibits discrimination and harassment and affords equal employment opportunities to employees and applicants without regard to any characteristic (or classification) protected by applicable law.#claimsSmoke-Free Iowa Statement: Nationwide Mutual Insurance Company, its affiliates and subsidiaries comply with the Iowa Smokefree Air Act. Smoking is prohibited in all enclosed areas on or around company premises as well as company issued vehicles. The company offers designated smoking areas in which smoking is permitted at each individual location. The Act prohibits retaliation for reporting complaints or violations. For more information on the Iowa Smokefree Air Act, individuals may contact the Smokefree Air Act Helpline at 888-944-2247.
For NY residents please review the following state law information: Notice of Employee Rights, Protections, and Obligations LS740 (ny.gov) https://dol.ny.gov/system/files/documents/2022/02/ls740_1.pdfNationwide pays on a geographic-specific salary structure and placement within the actual starting salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity and location of the role as well as the cost of labor in the market; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range.The national salary range for Claims Consultant, Casualty - E&S/Specialty : 91,000.00-187,000.00The expected starting salary range for Claims Consultant, Casualty - E&S/Specialty : 101,000.00 - 151,000.00