Complex Claims Consultant (Hybrid)

Position Compensation Range:

Pay Rate Type:

Compensation may vary based on the job level and your geographic work location. Relocation support is offered for eligible candidates.

Primary Accountabilities

• Lead resolution strategy for complex/high-exposure claims, applying strong coverage analysis, investigation planning, and negotiation.
• Provide technical guidance and consultationto adjusters and leaders on challenging coverage, liability, damages, litigation, and compliance questions.
• Serve as an escalation pointfor complex matters; align stakeholders and drive timely, defensible decisions.
• Coach and mentor claim handlers; deliver feedback that improves technical skill, documentation quality, and customer outcomes.
• Identify trends, training needs, and process gaps; recommend enhancements to improve consistency, quality, and cycle time.
• Partner with Legal, SIU, Underwriting, and other teams as needed to support case strategy and risk mitigation.
• Model strong decision-making, communication, and customer-centered claim handling practices.

Specialized Knowledge & Skills Requirements

• Demonstrated experience providing customer-driven solutions, support or service.

• Demonstrated ability to handle complex 1st and 3rd party, multi-line claims.

• Extensive problem-solving skill.

• Demonstrated experience with Quality Audit.

• Extensive knowledge of policies and endorsements coverages.

• Minimum of 7 years' experience handling complexity/high-severity claimswith strong technical judgment.
• Strong working knowledge of claim best practices: investigation, coverage interpretation, documentation, evaluation, and negotiation.
• Direct leadership experience(coaching, mentoring, consultation, and stakeholder alignment).
• Excellent written and verbal communication; ability to translate complexity into clear recommendations.
• Experience developing training, job aids, or technical guidance for claim teams.
• Experience handling complex claims on the East or West Coast.

Travel Requirements

• Up to 10%.

• Catastrophe travel up to 75%.

Physical Requirements

• Work that primarily involves sitting/standing.

• Offer to selected candidate will be made contingent on the results of applicable background checks

• Offer to selected candidate is contingent on signing a non-disclosure agreement for proprietary information, trade secrets, and inventions

• Sponsorship will not be considered for this position unless specified in the posting

The candidate(s) selected for this role will be employed by AFICS, Inc. (American Family Insurance Claims Services, Inc.), an affiliate of American Family Mutual Insurance Company, S.I.

We provide benefits that support your physical, emotional, and financial wellbeing. You will have access to comprehensive medical, dental, vision and wellbeing benefits that enable you to take care of your health. We also offer a competitive 401(k) contribution, a pension plan, an annual incentive, 9 paid holidays and a paid time off program (23 days accrued annually for full-time employees). In addition, our student loan repayment program and paid-family leave are available to support our employees and their families. Interns and contingent workers are not eligible for American Family Insurance Group benefits.

We are an equal opportunity employer. It is our policy to comply with all applicable federal, state and local laws pertaining to non-discrimination, non-harassment and equal opportunity. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law.

American Family Insurance is committed to the full inclusion of all qualified individuals. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please email AskHR@AmFam.com to request a reasonable accommodation.