Senior Claims Specialist, Professional Liability – Medical Malpractice

Role Overview

• To analyze complex or technically difficult medical malpractice claims
• Provide resolution of highly complex nature and/or severe injury claims
• Coordinate case management within Company standards, industry best practices and specific client service requirements
• Manage the total claim costs while providing high levels of customer service
• Analyzes and processes complex or technically difficult medical malpractice claims
• Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions
• Negotiates claim settlement up to designated authority level
• Calculates and assigns timely and appropriate reserves to claims
• Recommends settlement strategies
• Coordinates legal defense by assigning attorney
• Uses appropriate cost containment techniques to reduce overall claim cost for clients
• Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities
• Represents Company in depositions, mediations, and trial monitoring as needed
• Communicates claim activity and processing with the client
• Ensures claim files are properly documented and claims coding is correct
• Refers cases as appropriate to supervisor and management

Requirements

• Bachelor's degree from an accredited college or university preferred
• Six (6) years of claims management experience or equivalent combination of education and experience required
• In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent negotiation skills
• Good interpersonal skills
• Ability to work in a team environment

Benefits

• Flexible work arrangements
• Professional development opportunities