Sr. Claims Specialist – Professional Liability

Sr. Claims Specialist – Professional Liability

Requirements

• Bachelor’s degree from an accredited college or university preferred
• Licenses as required
• Professional certification as applicable to line of business preferred
• Six (6) years of related experience or equivalent combination of education and experience required to include three (3) years of claims management experience
• In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business
• 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
• Ability to meet or exceed Performance Competencies

Responsibilities

• Analyzes and processes medical malpractice claims by limited investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution
• Conducts or assigns limited 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; monitors reserve adequacy throughout claim life
• Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement
• Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients
• Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost
• Represents Company in depositions, mediations, and trial monitoring as needed
• Communicates claim activity and processing with the client; maintains professional client relationships
• Ensures claim files are properly documented and claims coding is correct
• Refers cases as appropriate to supervisor and management
• Performs other duties as assigned
• Supports the organization’s quality program(s)

Preferred Qualifications

• Bachelor’s degree from an accredited college or university preferred
• Professional certification as applicable to line of business preferred