Our Claims team is currently seeking a Technical Consultant Casualty Claims.
This is a full-time, exempt role with a hybrid work schedule (two days in the office) in one of our Hanover offices:
Howell, MI / Farmington Hills, MI
Southfield, MI
POSITION OVERVIEW:
The Technical Consultant, Casualty Claims, manages high-complexity no-fault claims involving moderate to high injury and disability severity. Duties include thorough coverage analysis, evaluating medical bills and other no-fault benefits for payment consideration, coordination and contact with claimants, third-parties and medical providers, skillfully negotiating settlements, and/or oversight of litigation strategy. Technical Consultants will collaborate with legal counsel, SIU teams, and medical experts to resolve claims efficiently while ensuring compliance with no-fault statutes and contributing to mentoring early in career staff.
This role requires advanced investigative and negotiation skills to resolve disputes and handle escalated situations, while collaborating with legal teams and subject matter experts as needed. The consultant analyzes complex data, provides expert opinions to support claim resolution, and may represent the company in litigation forums. Operating with a high degree of autonomy and professionalism, the position demands strategic thinking, deep technical expertise, and strict adherence to regulatory and company standards in navigating sensitive, high-impact claim scenarios.
IN THIS ROLE, YOU WILL:
Independently investigate moderate to complex and sensitive claims, ensuring thorough analysis and resolution.
Collaborate with internal and external experts to evaluate claims and determine validity and value.
Identify opportunities to transfer risk and pursue subrogation. Proactively resolve disputes, deescalate sensitive situations, and ensure optimal claim outcomes through strategic negotiation and litigation management.
Assess and transfer risk where appropriate; manage suspicious claims and refer to SIU as needed.
Serve as a subject matter expert and contribute to departmental projects and initiatives.
Draft coverage letters, including complex forms and endorsements; interpret commercial coverages and legal principles.
Set reserves and authorize payments within high authority limits; manage litigation budgets and counsel.
Lead quality and efficiency initiatives for complex claims workflows.
Use technology and data tools to identify trends, correct inconsistencies, and optimize outcomes.
Negotiate high-value and contested claims using advanced strategies.
Ensure compliance with jurisdictional requirements; mentor others on regulatory standards.
Maintain accurate records and prepare detailed reports; protect PII and educate peers on best practices.
Lead cross-functional meetings and drive consensus on claim resolutions.
Communicate complex information clearly to diverse stakeholders; manage sensitive customer interactions.
Provide technical guidance and mentorship to less experienced adjusters.
Represent the company in litigation forums including trials, mediations, and arbitrations.
Support training development and evaluate program effectiveness.
Influence product development by identifying coverage gaps and recommending updates.
Attend industry events and continuing education seminars to stay current with best practices, legal developments, and emerging trends.
Must possess or obtain and maintain appropriate state adjuster licenses and continuing education credits
WHAT YOU NEED TO APPLY:
Bachelor’s degree preferred or equivalent experience; typically 5+ years of industry experience; industry designation relevant to the role preferred
Recognized authority in negotiating highly complex claims; shapes and implements best practices
Skilled in negotiating complex claims and developing strategies to influence outcomes. Demonstrates sound judgment and decision-making on high-exposure cases, including litigation and compliance matters
Communicates…