CLAIMS CONSULTANT JOB DESCRIPTION

A Claims Consultant who loses track of a disputed coverage position can cost a commercial client hundreds of thousands of dollars before the error surfaces. Precision matters. In commercial P&C insurance, this role owns the client-facing claims function - interpreting policy language, advocating through carrier negotiations, and keeping every open claim moving toward fair resolution. The work spans commercial property, general liability, and casualty lines, demanding current knowledge of state adjusting license requirements and carrier-specific claims protocols. Few roles require this balance of legal fluency and client trust simultaneously.

As the Claims Consultant, you serve as the primary advocate between commercial policyholders and insurance carriers, translating complex coverage determinations into clear client guidance and driving timely claim closures across property and casualty lines. You operate within a brokerage or agency claims team, collaborating with account managers, legal counsel, and external adjusters while managing an active portfolio of commercial accounts under the oversight of a Regional or Senior Claims Manager.

Career Impact: Hands-on experience across commercial P&C lines, combined with an active multi-state adjuster license, builds rare technical credibility that distinguishes you in a market where most practitioners specialize in a single line.

Business Impact: Commercial clients facing losses depend on this role to prevent coverage gaps from becoming uncompensated claims, directly protecting policyholder assets and preserving long-term account relationships for the firm.

Growth Opportunity: The portfolio exposure and carrier relationships developed here create a direct path toward senior claims roles, claims management, or risk management advisory positions within the commercial insurance market.

• Review commercial P&C policies to evaluate coverage and advise clients and account teams on applicable terms and exclusions.
• Coordinate with insurance carriers, adjusters, and legal counsel to advance open claims toward timely and appropriate resolution.
• Monitor claim reserves, status updates, and closure timelines across an active portfolio in alignment with agency best practices.
• Advocate for clients during negotiations with carriers, preparing loss reports and identifying opportunities for subrogation or recovery.
• Investigate potentially fraudulent or complex claims, documenting findings and escalating per organizational authority thresholds.
• Prepare and deliver clear written and verbal claims status reports for client review meetings and senior management.
• Liaise with account managers and sales teams on coverage questions, onboarding calls, and claims review meetings.
• Guide and mentor junior claims staff and administrators on claims procedures and coverage interpretation.

• Bachelor's degree in Business, Finance, Risk Management, or a related field, or equivalent work experience.
• 3 or more years of commercial insurance claims experience, with demonstrated knowledge of property and casualty policy language and carrier procedures.
• Active Property & Casualty adjuster or agent license in required states, or ability to obtain within six months of hire.
• Proven ability to read, analyze, and apply coverage provisions across multiple commercial lines including property, general liability, and casualty.
• Strong written and verbal communication skills, with experience preparing formal claims correspondence and presenting findings to clients.
• Demonstrated organizational skills, including the ability to manage competing deadlines across a portfolio of concurrent open claims.
• Working knowledge of claims compliance requirements, including state-specific regulations and reporting obligations.

• Professional insurance designation such as CPCU, ARM, or AIC, indicating advanced technical grounding in commercial lines claims.
• Experience handling complex or high-exposure claims involving construction, reinsurance, or multi-jurisdictional coverage disputes.
• Familiarity with claims auditing procedures and reserve analysis within a multi-line commercial environment.
• Prior experience in a brokerage or MGA setting, with direct exposure to carrier stewardship meetings and coverage tender processes.

• Average claim cycle time, measuring how efficiently open commercial claims are advanced to closure.
• Reserve accuracy rate, reflecting how closely initial reserves align with final settlement values across the managed portfolio.
• Client SLA compliance percentage, tracking timely delivery of status updates and documentation against contractual service commitments.
• Subrogation and recovery identification rate, measuring dollar value of recoveries pursued relative to eligible claims volume.
• Coverage dispute resolution rate, tracking the proportion of carrier disputes resolved without escalation to litigation.
• Typical tools: Claims management platforms (commonly Guidewire ClaimCenter or similar); agency management systems (commonly Applied Epic or AMS360); productivity suites for reporting and correspondence.

• Base Salary Range: $60,000 to $95,000 annually, depending on seniority and state licensing
• Bonus: Performance-based bonus of 5% to 15% of base salary, tied to portfolio and SLA metrics
• Equity: Not typical at this level; may apply in private or PE-backed brokerage firms
• Health Benefits: Medical, dental, and vision coverage; employer contribution varies by firm size
• PTO: 15 to 20 days annually, plus standard US holidays
• Common Perks: Continuing education reimbursement for insurance designations, licensing fee coverage, hybrid work flexibility

Figures are estimates based on general US market benchmarks and may be outdated. Adjust based on location, company size, and seniority level.

Background check completion, including verification of licensing history and prior employment, is a condition of employment for this role. All qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other characteristic protected under applicable federal, state, or local law. Reasonable accommodations for individuals with disabilities are available upon request throughout the hiring process. Candidates must hold current authorization to work in the United States.

The Claims Consultant owns the end-to-end advocacy process for clients facing major losses, consulting on claims preparation and resolution while leading Account Managers and Brokers through coverage disputes with insurers. Reporting to the Regional Claims Manager, the role builds cross-functional claims resolution teams and maintains collaborative relationships with legal counsel and claims professionals to deliver consistent, high-quality outcomes.

Key Responsibilities

• Consult with clients on major losses, emphasizing claims preparation, submission, and resolution.
• Analyze claims and coverage issues while guiding the claims process.
• Research legal decisions and judgments on insurance contracts and claims as required.
• Lead Account Managers and Brokers in resolving coverage disputes with insurers.
• Prepare reports on claims disputes for management review and guidance.
• Make recommendations to clients for alternative dispute resolution as appropriate.
• Develop and coordinate a claims resolution team working with legal counsel or others as appropriate.
• Coordinate and attend claims settlement meetings with clients and insurers.
• Assist in the development and maintenance of quality control standards.
• Provide general guidance and support to the Claims Management Team as approved by the Regional Claims Manager.
• Build and maintain working collaborations with other claims professionals.
• Maintain accurate time management records.

Required Qualifications

• Minimum 5 years of commercial claims handling experience in the property/casualty sector preferred.
• General insurance experience is an asset.
• Strong digital literacy and proficiency with the Microsoft Office Package required.
• Strong organizational skills with the ability to prioritize under pressure of competing deadlines.
• Excellent interpersonal, communication, and presentation skills.
• Ability to work as a key team member and independently with minimal supervision.
• Client relationship-focused with a professional and approachable manner.

Embedded within the client services team, the Claims Consultant develops and maintains relationships with clients and carriers while preparing loss reports and identifying trends to support the claims process. Working closely with account managers, adjusters, and carriers, the consultant advocates for clients from first notice of loss through resolution, ensuring compliance with government agencies and corporate policies throughout.

Core Functions

• Develop and maintain relationships with clients and carriers through calls, meetings, and seminars.
• Work with assigned book of clients to provide clarity on coverage matters.
• Report losses to appropriate carriers.
• Communicate with clients and adjusters pertaining to the handling of claims.
• Monitor the status of open claims.
• Prepare loss reports and identify loss trends for clients, account managers, and relevant stakeholders.
• Advocate for the client during the claims process.
• Assist with the collection of denied claims from carriers to clients.
• Ensure compliance with government agencies and corporate policies and procedures.
• Attend training sessions and courses to maintain up-to-date skills.

Qualifications & Experience

• Associate degree (AA) or equivalent from a two-year or technical school.
• Active Property and Casualty Agent License for all required states, or obtain within six months.
• 2 to 5 years of commercial insurance claims experience.
• Basic knowledge of property and casualty coverage, current legislation, rules, and regulations.
• Comprehensive knowledge of contracts and their provisions.
• Proficiency with Microsoft Windows, Office365, Word, and Excel.
• Insurance software experience.
• Exceptional telephone demeanor with the highest level of confidentiality maintained at all times.

Reporting to the Divisional Manager, the Claims Consultant administers new claims end-to-end, including gathering information, calculating settlements, and processing payments across motor and property lines. Partnering with internal stakeholders such as Trust Administrators and Fund Managers, as well as external repairers and assessors, the consultant ensures prompt settlement in line with GICOP requirements and quality assurance standards.

Primary Duties

• Manage and administer new claims, liaising with customers, repairers, suppliers, and other parties.
• Undertake technical claims administration including gathering information, determining claims, preparing correspondence, calculating settlements, and processing payments.
• Assist the Divisional Manager with preparation, monitoring, and analysis of claims data as required.
• Identify and pursue all opportunities for recovery.
• Monitor outstanding claims via a diary system to ensure prompt settlement in line with GICOP requirements and quality assurance standards.
• Build and maintain good rapport with internal and external customers and stakeholders.
• Provide claims support and information while operating in a team environment.

Skills & Qualifications

• Experience in end-to-end Motor and/or Property claims.
• Knowledge of the recoveries process.
• Understanding of policy covers and policy wordings.
• Capacity to recognize trends and anomalies in claims data.
• Decision-making skills with the ability to work unsupervised.
• Excellent communication and interpersonal skills.
• Ability to work well within a team.

Sitting at the intersection of medical case management and insurance liability, the Claims Consultant independently manages a portfolio of life insurance claims end-to-end, assessing and finalizing payments while engaging treating doctors, rehabilitation consultants, and in-house legal specialists. Operating within a claims assessing team and collaborating with third-party service providers, the consultant delivers timely outcomes for customers including income protection, TPD, and trauma claims.

Duties

• Independently manage a portfolio of life insurance claims end-to-end.
• Assess, analyze, calculate, and finalize claims payments.
• Actively engage external treating doctors, rehabilitation consultants, and in-house medical and legal specialists to deliver timely outcomes.
• Provide exceptional customer service in accordance with policy and claims procedures.
• Participate in case conferences, peer case discussions, and instruct third-party service providers.

Experience & Qualifications

• Experience in insurance claims assessment or claims management in a similar role.
• Life insurance experience highly desirable, including income protection, TPD, death, trauma, or lump sum claims.
• Medical, vocational, rehabilitation, or legal experience relating to injury or TPD.
• WorkCover claims assessing experience viewed favorably.
• Strong customer and key stakeholder focus with sound communication and decision-making skills.
• Ability to build rapport and empathy with customers during difficult times.
• Experience supporting customers in returning to work or regaining quality of life.

A key member of the warranty claims team, the Claims Consultant manages Home Builders Warranty claims end-to-end in adherence to HBCF service standards, delegated authority, and company guidelines, delivering outstanding outcomes for homeowners. Collaborating across internal teams and external business relationships, the consultant achieves monthly efficiency targets while sharing information and resources to support the best possible claim outcomes.

Functions

• Manage Home Builders Warranty claims end-to-end with adherence to HBCF service standards, company guidelines, and delegated authority.
• Deliver outstanding outcomes and customer service for both homeowners and HBCF.
• Work with the team by sharing information, knowledge, and resources to achieve the best possible outcomes.
• Build and develop external business relationships.
• Attend client meetings where applicable.
• Achieve monthly efficiency levels as designated by management.

Position Requirements

• Minimum 3 years of claims experience, preferably in Householders, Property, Commercial, or Builders Warranty claims.
• Ability to interpret policy wordings and apply them accurately to individual claims.
• Knowledge of and adherence to relevant state legislation.
• Advanced computer skills, including Microsoft Office Word and Excel.
• Guidewire Claim Centre experience and ANZIIF industry qualification desirable but not essential.
• Strong attention to detail with a commitment to quality and accuracy.
• Strong interpersonal skills with the ability and desire to work as part of a team.

Consistent end-to-end claims resolution within predefined SLAs depends on the Claims Consultant, who manages inbound and outbound calls, coordinates with internal staff and external contractors, and improves the customer experience at every touch point. Based within a contact centre environment, the consultant handles home claims queries, performs data entry, and updates file notes while maintaining strong internal and external relationships.

Accountabilities

• Interact with customers, clients, trades, and internal staff to build strong relationships and capture critical information to resolve claims queries.
• Book claims and manage inbound and outbound calls.
• Coordinate with internal staff and external contractors.
• Respond to client, customer, and trade-related queries via phone and email.
• Perform data entry, update file notes, and carry out general administrative duties.
• Manage the end-to-end claims process within predefined SLAs while improving the customer experience at each touch point.

Requirements

• 1 to 2 years of experience working in a contact centre environment.
• Previous experience in home claims management desirable.
• Intermediate computer skills with close attention to detail.
• Strong organization and time management capabilities.
• Effective written and verbal communication skills.
• Proactive, committed, and personable team player.
• Passion for continuous improvement and drive for results.

As the Claims Consultant, this role processes all incoming insurance claims and manages end-to-end claims in accordance with the General Insurance Code of Practice, delivering a consistent and trusted customer experience across all touchpoints. The claims team relies on this work to achieve individual KPIs and targets while maintaining compliance with risk and regulatory requirements throughout the claims lifecycle.

What You'll Do

• Process all incoming insurance claims and manage end-to-end claims.
• Provide timely and effective responses to customer enquiries.
• Develop customer relationships to understand requirements and deliver a positive, trusted customer experience.
• Deliver a consistent and appropriate high level of customer service at all touch points.
• Demonstrate adherence to risk and compliance as per the General Insurance Code of Practice.
• Achieve individual KPIs and targets.

Knowledge, Skills & Abilities

• Ability and experience optimizing business value by delivering a positive customer experience.
• Proactive approach to problem-solving with strong decision-making capabilities.
• Ability to recognize, avert, manage, and escalate conflicts.
• Close attention to detail with thoroughness and accuracy in completing tasks.
• Ability to plan, prioritize, and manage competing resources and demands effectively.
• Excellent verbal and written communication skills.

Claims Consultant delivers coverage determinations and customer-aligned outcomes by reviewing claim circumstances against applicable insurance policies and engaging key stakeholders with clear instructions throughout the assessment process. Success in the position means ensuring claim outcomes are consistently delivered in accordance with client SLAs and KPIs while utilizing technology tools to make well-informed decisions.

Day-to-Day Responsibilities

• Conduct claims assessments by reviewing information and engaging with customers to determine required actions.
• Consider claim circumstances against the applicable insurance policy and determine coverage.
• Ensure claim outcomes are delivered in accordance with KPIs and client SLAs.
• Engage and appoint key stakeholders to a claim with clear and concise requirements and instructions.
• Utilize technology tools to understand situations and make decisions.
• Provide outcomes consistent with the customer experience standard.

Background & Experience

• 1 or more years of experience in insurance, property inspections, or property claims.
• Experience in stakeholder and client relationship management.
• Ability to understand client policies and guidelines.
• Strong negotiation skills and confidence to make independent decisions.
• High attention to detail.
• Demonstrated ability to work collaboratively and multitask.

The Claims Consultant produces timely and high-quality claim determinations and payments by managing high volumes of inbound calls and overseeing end-to-end claims from intake through resolution. Reporting to the claims operations team, the consultant applies knowledge of legislative and business requirements to individual claims while meeting customer service standards across every interaction.

Role Responsibilities

• Take high-volume inbound calls.
• Manage end-to-end claims for determination and payment.
• Provide customers with optimal customer service, including quality and timely decisions.
• Develop specific knowledge around individual claims.
• Manage policies and procedures and meet legislative and business requirements.

Minimum Qualifications

• Minimum 2 years of customer service experience, preferably in a call centre environment.
• Previous exposure to insurance and claims, with attention to detail.
• Intermediate computer literacy.
• Strong communication skills with proven experience in negotiation and managing difficult calls.
• Adaptable and agile learning style with motivation to deliver results efficiently.
• Open and eager to learn new processes and systems.

Embedded within the technology consulting team, the Claims Consultant develops and delivers SAP FS Claims Management solutions, including solution design, technical architecture, and system configuration across motor and P&C insurance domains. Working closely with onshore and offshore teams as well as customer stakeholders, the consultant provides inputs to proposals, trains junior resources, and acts as the single point of contact for the onsite delivery team.

Job Functions

• Work with customer resources to fully understand issues and deliver activities as per agreed timelines.
• Gather and analyze requirements, design solutions, create documentation, secure approvals, and build, test, and deliver solutions.
• Work on incidents, minor and major changes, and projects.
• Participate and contribute in all internal and customer meetings.
• Understand and ensure adherence to established customer and organizational processes.
• Provide inputs to proposals in the respective technology area.
• Train new and junior resources in their area of expertise.
• Act as SPOC and conduit for offshore teams in the relevant area of expertise.

Education & Experience

• Completed university degree.
• Experience in SAP FS Claims Management implementation and support for 5 to 6 years.
• Experience in solution design and implementation, including technical architecture for SAP FS-CM.
• Exposure to interfaces with systems such as FSCD and policy management.
• Working knowledge of claims processes for motor insurance and P&C, including claims notification, fulfilment, handling, and recovery.
• Experience in product configuration, claim handling configuration, user interface configuration, business rules framework, and structured facts capture.
• Good knowledge of German and English.
• Strong communication, presentation, and intercultural skills.
• High willingness to travel and international experience.

Reporting to the claims team leadership, the Claims Consultant refines the caller experience by assessing caller needs, coordinating calendars, monitoring claims against service level agreements, and preparing accurate documentation for customers and clients. Partnering with the broader claims team to provide administrative support, the consultant keeps customers informed of progress and maintains constant file notes across CRM platforms to support seamless claims processing.

Scope of Work

• Proactively monitor claims to ensure all processing is in line with service level agreements.
• Review claim details and proactively assist in the correct actions being taken.
• Prepare and submit professional and accurate documentation to customers and clients.
• Update CRM platforms, keeping constant and accurate file notes.
• Provide administrative support to the claims team.

Professional Experience

• Previous experience managing customer enquiries in a busy call centre or customer service environment.
• Experience managing home claims is highly desirable.
• Strong verbal and written communication skills.
• Strong time management skills with the ability to coordinate several priorities at any one time.
• High level of attention to detail with a commitment to accuracy and performance.
• Confident in learning, accessing, and utilizing a variety of systems and software.
• Demonstrated track record of performance against targets, deadlines, and KPIs.

Sitting at the intersection of complex coverage evaluation and multi-line claims operations, the Claims Consultant oversees the timely evaluation, reserving, settlement, and disposition of assigned claims across all lines of business as the highest-level individual contributor on the team. Operating across commercial property, casualty, and specialty lines, the consultant investigates fraud, identifies subrogation opportunities, and travels to mediations and settlement conferences as required.

Leadership Responsibilities

• Evaluate, reserve, settle, and manage disposition of assigned claims on time.
• Document coverage, investigation, damages, reserve rationale, and negotiations associated with each claim.
• Investigate potentially fraudulent claims and take appropriate action.
• Identify opportunities for contribution, subrogation, and recovery on claims.
• Prepare required reports for senior management.
• Travel to mediations or settlement conferences as required.

Education & Experience

• Bachelor's degree or equivalent work experience required, with advanced degrees or insurance designations a plus.
• Claims adjuster license required.
• 7 to 10 years of experience handling claims in a commercial multi-line insurance environment.
• Prior supervisory or lead experience with depth of knowledge across Claims Auditing.
• Experience in reviewing coverage, drafting coverage correspondence, and responding to tenders across multiple lines of business.
• Experience handling claims on behalf of a syndicate, insurance company, MGA, broker, or independent loss adjuster.
• Solid understanding of performance metrics and KPIs.
• Intermediate to advanced skills with Excel, Word, PowerPoint, Outlook, OneNote, and SharePoint.
• Expert comfort level with remote and virtual working practices and platforms.
• Excellent written and verbal communication skills.
• Valid licenses in required and additional states as needed.

A key member of the agency claims team, the Claims Consultant advances commercial property and liability claims from first report through closure by serving as a liaison between clients and carriers and monitoring reserves for proper levels in accordance with best practices. Collaborating across sales, service, and account teams, the consultant participates in onboarding and claims review calls and serves as a technical resource on coverage and procedural questions.

Strategic Responsibilities

• Report commercial property and liability claims to appropriate carriers on behalf of clients.
• Ensure clients understand the claims process and timelines.
• Perform timely data entry of claims information into the agency management system.
• Act as a liaison between client and carrier to facilitate the exchange of claims information.
• Monitor and manage claims for proper reserves, appropriate actions, and closure in accordance with best practices.
• Identify problematic claims and take action to mitigate potential adverse effects.
• Serve as a technical resource to sales and service teams on coverage and procedural questions.
• Participate in onboarding and claims review calls with selected clients.

Qualifications & Experience

• College degree or equivalent combination of education and experience.
• Florida 2-20 License or 6-20 Adjuster License, or equivalent from another state.
• Minimum 3 years of commercial insurance account management or multi-line claims experience.
• Working knowledge of the latest Microsoft products.
• Strong telephone and business writing skills with knowledge of email etiquette.
• Effective reasoning and analytical skills with the ability to manage multiple tasks.
• Excellent organizational skills with high attention to detail.
• Responsive and self-motivated team player.

Timely resolution of Construction and NY Labor Law claims across the full vendor and carrier network depends on the Claims Consultant, who leads stewardship meetings, reviews contracts for tender opportunities, and develops Special Account Instructions to guide carrier and TPA handling on behalf of clients. Serving as the senior technical resource for claim activities, the consultant works with Risk Managers, Carriers, TPAs, and defense counsel while also supporting new business development and Risk Management Program creation.

Ownership Areas

• Lead the claims discussion in Stewardship Meetings with the account team.
• Review contracts for potential tender opportunities and discuss merits with Carrier and TPA partners.
• Facilitate and participate in claim-related meetings with carrier and TPA partners.
• Work with clients and Account Executives to create standardization in Additional Insured and Indemnification contract language.
• Develop relationships with key third-party vendor experts including Defense Counsel, TPAs, and Adjustment Firms.
• Develop Special Account Instructions for clients to guide claims handling with carrier and TPA partners.
• Assist in reporting new losses for clients, reviewing for proper notice and following through to claim closure.
• Develop and maintain strong working relationships with insurers, wholesale brokers, and strategic industry partners.

Required Qualifications

• Bachelor's degree required; Juris Doctorate highly preferred but not required.
• 6 to 10 or more years of Construction and NY Labor Law Claims experience.
• Strong knowledge of policy language and coverage across multiple lines.
• Solid analytical skills and business acumen.
• Strong communication abilities.

As the Claims Consultant, this role guides a portfolio of workers' compensation claims through strategic case management, supporting injured workers and employers with entitlement reimbursements, case conferencing, and liability reduction decisions. The claims team relies on this work to return injured workers to health and employment while maintaining adherence to organizational work practices and relevant legislation throughout the process.

Performance Expectations

• Effectively manage a portfolio of claims through the development of key strategies to reduce liabilities.
• Support workers and employers with ongoing case management and injury management strategies, including timely reimbursement of entitlements.
• Deliver timely claim closures through effective case conferencing and completion of associated actions.
• Ensure adherence to organizational work practices in support of case management.
• Contribute to a team focused on achieving performance excellence.

Skills & Qualifications

• Workers' Compensation Claims management experience or an understanding of injury and claims management concepts desirable.
• Ability to understand and apply relevant legislation.
• Strong customer service, interpersonal, and negotiation skills.
• Excellent written and verbal communication skills.
• Conflict resolution skills with the ability to make decisions within company guidelines.
• Confidence to engage and negotiate with a broad range of stakeholders, including injured workers, employers, and medical practitioners.
• Ability to manage time effectively, prioritize tasks, and work with initiative within a team environment.

Claims Consultant expands the construction attorney market by managing expert claims analysis, overseeing complex construction claims preparation, and promoting claims services to establish professional client relationships. The work directly supports clients on large and complex Heavy Civil and Building construction projects, with a focus on delay analysis, dispute resolution through mediation and arbitration, and deep knowledge of construction contracts and contractor means and methods.

Technical Responsibilities

• Expand the construction attorney market.
• Manage and perform expert claims analysis and resolution assignments.
• Oversee the claims team in the analysis or preparation of complex construction claims.
• Market and promote construction claims services, project management, financial planning, and control.
• Establish and maintain professional business relations with clients.
• Interface effectively with clients, coworkers, and other stakeholders.

Education & Experience

• Bachelor of Science in Construction Management, Civil, Mechanical, or Electrical Engineering, Architecture, or a related degree.
• Active involvement in ABA, California Lawyers Association, or other construction attorney associations.
• Minimum 15 years of construction and/or construction claims experience.
• Experience in Project Controls, CPM scheduling, delay analysis, and productivity analysis.
• Experience in claims and dispute resolution, including mediation, dispute review boards, arbitration, and litigation.
• Experience on large and complex construction projects, including Heavy Civil or Building construction.
• Deep understanding of construction contracts, construction principles, and contractor means and methods.
• Exceptional written and verbal communication and organizational skills.

The Claims Consultant creates fair and compliant settlement outcomes for motor damage customers by managing their journey through AMS, identifying and eliminating process failure points, and maintaining full compliance with CPC, DPA, CICA, and all relevant legislation. Reporting to the motor claims leadership, the consultant translates customer feedback into actionable process improvements and builds positive relationships with colleagues and external partners to enhance the overall customer experience.

Key Deliverables

• Manage and agree solutions with customers.
• Manage the customer journey through AMS, identifying and eliminating failure points and resolving issues independently.
• Maintain the quality of the portfolio with full compliance with CPC, DPA, CICA, and all relevant legislation.
• Handle external and internal partner queries on AMS cases.
• Understand customer feedback on the AMS process and translate it into actionable improvements.
• Build positive relationships with colleagues and external partners in a professional and approachable manner.
• Share findings and feedback with colleagues to improve processes and increase customer experience.

Requirements

• CIP or APA Qualification, or close to completion.
• Proven experience in Motor Damage claims handling.
• Background of learning agility in a sophisticated and changing environment.
• Ability to manage your own workload with strong problem-solving abilities.
• Track record of robust relationship-building, negotiation, and communication skills with a strong customer focus.
• Ability to make real-time decisions based on changing information.

Embedded within a field and desk-based property claims team, the Claims Consultant executes residential and commercial property claim settlements from instruction to completion within agreed financial authority limits, covering flood, fire, and water damage restoration across a designated geographic patch. Working closely with customers, internal management systems, and local market contacts, the consultant provides repair estimations using claims scoping software and supports major incidents through UK-wide travel when required.

Areas of Ownership

• Investigate, validate, manage, and settle residential and/or commercial property claims in line with policy cover, philosophies, and standards.
• Refer cases outside of agreed financial or competency matrix if required.
• Undertake field and desk assessments to maximize efficiencies and outcomes.
• Provide estimation of insurance-related repairs using claims scoping software.
• Update customers regularly to ensure optimum customer service and claims experience.
• Identify and capture fraud and recoveries information and data.
• Manage work in progress by updating claims management and estimating systems to maintain a real-time view for customers and the business.
• Identify and share market, legal, and technical trends and developments.

Technical Qualifications

• Knowledge of insurance industry principles, ideally related to managing home and property claims.
• Relevant technical expertise in flood, fire, and water damage restoration, technical buildings methodology, and claims scoping is highly desirable.
• Experience working in a customer-facing insurance environment with commercial awareness.
• IT literate with ability to learn new technologies.
• Committed to growing knowledge through technical, theoretical, and practical means.
• Ability to work flexibly outside standard, managing own diary.
• Full driving licence with ability to travel regularly across the designated patch and UK-wide as needed.

Reporting to the P&C claims team leadership, the Claims Consultant coordinates claim resolution by acting as a liaison between insureds and carriers, reviewing policies for coverage evaluation, and monitoring claims activity from first notice through closure across evolving risk and exposure types. Partnering with adjusters, attorneys, and account teams while mentoring Claims Administrators, the consultant advances coverage literacy across the organization and supports continuing education to stay current on market trends and litigation developments.

Key Responsibilities

• Act as a liaison between clients and insurance carriers to facilitate resolution of claims.
• Review policies to evaluate coverage and advise clients and account teams to set appropriate expectations.
• Monitor claims activity and results.
• Communicate with clients, adjusters, carriers, and attorneys to move claims toward resolution.
• Respond to questions and inquiries from clients, account teams, and carriers.
• Participate in claim reviews with clients and account teams.
• Support the claims team in developing reports.
• Provide mentoring and training to Claims Administrators.

Qualifications & Experience

• Bachelor's degree preferred.
• Active CA Department of Insurance license with continuing education requirements maintained; additional insurance designations or claims coursework considered an asset.
• Minimum 2 years of insurance industry background or demonstrated knowledge of insurance coverage concepts.
• Ability to read, understand, and analyze coverage across various P&C policy types.
• Proficiency with Microsoft Office products, including Word, Excel, and PowerPoint.
• Experience working with carrier claims portals.
• Strong organizational skills with thoroughness and attention to detail.
• Excellent verbal and written communication skills.
• A results-oriented, client-focused approach.
• Ability to multi-task, manage competing priorities, and work independently with minimal supervision.

Sitting at the intersection of reinsurance contract interpretation and complex casualty claims management, the Claims Consultant handles high-exposure assumed reinsurance claims spanning asbestos, toxic tort, pollution, E&O, and D&O lines, requiring independent liability evaluation, reserve analysis, and negotiation with ceding companies and brokers. Operating across legal, finance, and underwriting functions while overseeing defense counsel and training Claims Representatives, the consultant also conducts ceding company audits and communicates claim status regularly to company management.

Strategic Responsibilities

• Approve or deny company-assumed policy payments and communicate positions to brokers and ceding companies.
• Evaluate claim information from ceding companies and brokers, applying and interpreting coverage against investigation material.
• Monitor claims to closure, performing continuous review of the assigned claims inventory.
• Identify treaty involvement and claims with potential for retrocessional reinsurance recovery.
• Negotiate resolution of disputed positions with ceding companies and assist in drafting settlement documents.
• Oversee defense counsel in all lawsuit activities and manage litigation as appropriate.
• Provide reserve analysis to ensure timely and accurate case reserves.
• Train, direct, and guide Claims Representatives and provide specialized consultation to non-claims areas.

Education & Experience

• Undergraduate degree in a related field preferred, with post-graduate studies such as MBA or JD desired.
• State licensing and relevant professional designations such as CPCU or ARe desirable.
• 8 to 10 years of progressive primary, excess, or reinsurance commercial casualty claims experience, preferably in asbestos, toxic tort, or pollution.
• Proven in-depth knowledge of reinsurance contracts, ceded claims processes, and legal aspects of reinsurance claims.
• Demonstrated analytical skills to make independent decisions on coverage application, jurisdictional law, and treaty exclusions.
• Advanced verbal and written communication skills for interaction with ceding companies, brokers, counsel, and internal customers.
• Ability to function with minimum supervision and effectively manage conflict.