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