Liability Claims Advisor

ESSENTIAL FUNCTIONS And RESPONSIBILITIES

• Analyzes and processes complex or technically difficult medical professional liability claims by 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 full investigation and provides a 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.
• Performs coverage analysis and opinion as part of the claim process including all necessary correspondence.
• Coordinates legal defense by assigning attorneys, coordinating support for the 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 costs for our clients.
• Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
• Represents the 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.
• Delegates work and mentor others.
  

ADDITIONAL FUNCTIONS And RESPONSIBILITIES

• Performs other duties as assigned.
• Travels as required.
  

QUALIFICATIONS

Education & Licensing

• A bachelor's degree from an accredited college or university is required. Professional certification as applicable to the line of business preferred.
  

Experience

• Six (6) years of medical malpractice claims management experience or equivalent combination of education and experience preferred.
  

Skills & Knowledge

• 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
• Claims expertise in medical malpractice
• 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