Senior Risk Management Claims Consultant

Job Description

Job Description

Overview

At Community Financial System, Inc. (CFSI), we are dedicated to providing our customers with friendly, personalized, high-quality financial services and products. Our retail division, Community Bank, N.A., operates more than 200 customer facilities across Upstate New York, Northeastern Pennsylvania, Vermont and Western Massachusetts. Beyond retail banking, we also offer commercial banking, wealth management, investment management, insurance and risk management, and benefit plan administration.

 

Just as our employees are committed to helping our customers manage their finances, we’re committed to our employees. After all, they make it happen for our customers every day.

 

To ensure our people can enjoy long and successful careers here at CFSI, we offer competitive compensation, great benefits, and professional development and advancement opportunities. As an equal-opportunity workplace and affirmative-action employer, we celebrate and support a diverse workplace for the benefit of all: our employees, customers and communities.

Responsibilities

JOB SUMMARY:

The Senior Claims Consultant is a highly experienced, client-facing technical advisor who leads claims advocacy and strategic consultation across commercial Property & Casualty lines, excluding Workers’ Compensation. The consultant helps clients understand what to do before, during, and after a loss; engages the appropriate carrier resources; monitors claim direction; and keeps clients and internal teams informed with clear, practical guidance.

 

This role combines advanced technical claims knowledge, confident carrier navigation, executive-level client communication, relationship management, and strong business judgment. The Senior Claims Consultant independently leads high-severity, complex, litigated, sensitive, and coverage-challenged matters and coordinates with leadership, legal counsel, and other specialists when additional authority or formal legal interpretation is required. The consultant also contributes to onboarding, renewal, stewardship, and new-business activities so claims expertise becomes a proactive and visible part of the OneGroup client experience.

 

1. Client Advocacy and Claim Lifecycle Management

• Serve as the senior claims advisor for assigned clients and the lead advocate on complex, high-severity, litigated, sensitive, or strategically important P&C claims.
• Assess the facts, urgency, operational impact, coverage concerns, and client needs at the outset of a claim and establish an appropriate engagement plan.
• Guide clients on immediate actions, documentation, preservation of evidence, communication protocols, and realistic next steps without providing legal advice.
• Lead complex P&C claims independently, establish claim strategy, coordinate stakeholders, monitor execution, and escalate only when formal legal interpretation, executive authority, or extraordinary exposure requires additional support.
• Provide proactive updates that explain material developments, business implications, open questions, responsibilities, and next actions in plain language.
• Lead large-loss reviews, claim strategy meetings, war rooms, stewardship discussions, executive claim presentations, and post-loss debriefs.
• Build trusted relationships with client leadership, risk contacts, Producers, Account Executives, Account Managers, and other internal partners.

1. Carrier Navigation, Accountability, and Relationships

• Act as an informed and constructive liaison between the client and carrier, TPA, adjuster, counsel, expert, or vendor.
• Understand the claims organization, intake model, escalation path, key contacts, adjuster structure, and service expectations of OneGroup’s priority carriers.
• Engage adjusters and carrier leaders confidently to clarify strategy, obtain timely responses, address stalled activity, and resolve service concerns.
• Review claim action plans, investigation status, liability assessment, reserve activity, settlement posture, litigation developments, and closure opportunities.
• Advocate for appropriate carrier review when handling, communication, reserves, or coverage positions appear inconsistent with the available facts, policy language, or agreed service expectations.
• Escalate unresolved concerns through appropriate carrier channels while preserving productive long-term relationships.
• Document carrier knowledge, contacts, processes, and lessons learned in reusable playbooks that strengthen the broader Claims and account service teams.
• Provide claims-based feedback for carrier selection, placement, renewal, and broader carrier relationship discussions.

1. Coverage Consultation and Complex Issue Recognition

• Review relevant policy language, endorsements, exclusions, deductibles, retentions, reservation-of-rights letters, coverage positions, and denials.
• Explain potential coverage and claim-handling issues clearly while maintaining the distinction between OneGroup’s advocacy role and the carrier’s authority to determine coverage.
• Recognize and escalate matters involving disputed coverage, significant financial exposure, litigation, reputational risk, unusual facts, or potential errors and omissions exposure.
• Identify potential subrogation, tender, contractual indemnification, risk-transfer, recovery, and preservation-of-evidence opportunities.
• Coordinate with internal leadership or legal counsel when formal legal interpretation or privileged advice is required.

1. Proactive Client Education and Preparedness

• Participate in new-client onboarding, carrier transitions, renewals, and service planning to establish expectations before a loss occurs.
• Help clients understand whom to contact, how and when to report an incident, what information to preserve, and what to expect from the carrier after reporting.
• Develop and deliver practical claim-reporting guides, emergency-response checklists, documentation tools, and short educational resources for common P&C scenarios.
• Adapt guidance to the exposure, including property damage, automobile accidents, premises liability, cyber events, and other coverage-specific incidents.
• Conduct post-loss reviews and recommend improvements to client procedures, internal handoffs, reporting practices, and loss-mitigation efforts.

1. Claims Analytics, Stewardship, and Business Partnership

• Review loss runs and claim inventories for severity, duration, reserve movement, closure activity, recurring causes, and carrier performance patterns.
• Translate claim data and file developments into practical recommendations for service plans, stewardship, renewals, retention, and risk mitigation.
• Prepare concise executive-level claim summaries and presentations that connect technical developments to operational and financial implications.
• Partner with Risk Management Consultants to convert claim trends into targeted prevention and mitigation opportunities.
• Support prospective-client and retention conversations when claims expertise strengthens OneGroup’s value proposition.
• Document client touchpoints, recommendations, follow-up commitments, and outcomes so the value of claims consulting can be measured.

1. Workflow, Documentation, and Team Collaboration

• Maintain accurate, timely, and decision-useful claim documentation in Applied Epic and other approved systems.
• Use established workflows, templates, automation, and approved AI-enabled tools to reduce repetitive work while preserving professional judgment and data quality.
• Coordinate effectively with Claims Intake, account service, Risk Management, Producers, and senior claims resources, with clear handoffs and ownership.
• Escalate complex matters with a concise summary of facts, coverage, status, concerns, supporting documentation, and recommended next steps.
• Contribute to carrier playbooks, claim procedures, service standards, escalation matrices, client resources, and continuous process improvement.
• Protect confidential information and follow applicable privacy, cybersecurity, documentation, licensing, and E&O risk-management requirements.
• Help shape the future claims operating model by identifying opportunities for better workflows, technology, automation, role clarity, and measurable client value.
• Represent Claims in strategic client, prospect, renewal, carrier, and cross-functional conversations when senior expertise can influence retention, placement, or business outcomes.
• Review significant claims and emerging patterns across the portfolio to identify systemic carrier, coverage, process, or client-risk concerns.
• Lead the development and consistent application of P&C claims service standards, complexity criteria, escalation protocols, carrier playbooks, and client-facing resources.
• Provide coaching and practical guidance on claim strategy, coverage concerns, carrier escalation, client communication, documentation, and professional judgment.
• Serve as the senior technical escalation resource for Claims Consultants, intake professionals, Producers, Account Executives, Account Managers, and Risk Management Consultants.

Qualifications

MINIMUM QUALIFICATION REQUIREMENTS:

Education/Experience:

• Seven or more years of progressively responsible commercial P&C claims experience with a carrier, TPA, brokerage, independent adjusting firm, or comparable claims organization, including direct responsibility for complex or high-severity matters.
• Broad working knowledge of commercial property, general liability, and commercial auto claims, with the ability to recognize issues across specialty P&C lines.
• Demonstrated ability to communicate and negotiate effectively with insurance carriers, adjusters, clients, counsel, vendors, and internal business partners.
• Experience reviewing claim developments, coverage correspondence, reserves, litigation activity, settlement considerations, and carrier service performance.
• Strong client presence, written communication, organization, follow-through, judgment, and ability to manage multiple active matters.
• Comfort working in Applied Epic or a similar agency or claims-management system and proficiency with Microsoft 365 tools.

Preferred Education, Certifications and Licenses:

• Associate or bachelor’s degree in insurance, risk management, business, finance, or a related field.
• Associate in Claims (AIC), Chartered Property Casualty Underwriter (CPCU), Associate in Risk Management (ARM), or comparable designation.
• Property & Casualty producer license and/or appropriate adjuster licensing based on jurisdiction and assigned duties.
• Experience with large, complex, or multi-location commercial clients; claim reviews; stewardship; loss-run analysis; and executive presentations.
• Experience building productive working relationships within carrier claims organizations and navigating supervisory escalation channels.
• Demonstrated experience mentoring claims professionals, leading technical reviews, or developing claims practices and service standards.

Experience/Skills:

• Client advocacy and consultative presence
• Commercial P&C claims judgment
• Carrier navigation and constructive influence
• Coverage and policy analysis
• Negotiation, escalation, and conflict resolution
• Clear executive and client communication
• Analytical thinking and business acumen
• Relationship management and collaboration
• Documentation discipline and professional discretion
• Adaptability, curiosity, and continuous improvement

 

TRAVEL:

Will require routine travel to client, carrier, and OneGroup locations.