Sr. Claims Specialist, Medical Malpractice | Professional Liability
New
J
JobgetherMedical malpractice insurance
Based in the United StatesFull-TimeSenior
SalaryAt least 125,000 USD per year
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Job Details
- Experience
- At least 6 years of claims management experience, or an equivalent combination of education and professional experience.
- Required Skills
- Microsoft Office
Requirements
- At least 6 years of claims management experience, or an equivalent combination of education and professional experience.
- In-depth knowledge of medical malpractice insurance principles, relevant laws, and professional liability claims practices.
- Understanding of recoveries, offsets, deductions, claim duration, and cost containment strategies.
- Familiarity with medical management practices and related claims procedures.
- Strong investigation, analytical, and interpretive skills for assessing complex claim information.
- Strong negotiation and interpersonal skills for working with clients, attorneys, vendors, and colleagues.
- Excellent oral and written communication skills, including report preparation, client communication, and presentations.
- Excellent organizational skills, sound judgment, and ability to manage priorities and meet deadlines.
- Proficiency with Microsoft Office and general computer applications.
- Ability to work independently and contribute effectively within a team.
- Relevant professional licenses as required for the role.
- Bachelor's degree and professional certification applicable to the line of business preferred.
- Willingness and ability to travel as required.
Responsibilities
- Investigate and manage complex medical malpractice claims, assess exposure, and determine resolution strategies.
- Develop and execute claim action plans and prepare detailed investigation reports.
- Negotiate settlements within designated authority limits and recommend settlement strategies.
- Establish and regularly review claim reserves.
- Evaluate structured settlement opportunities when appropriate.
- Coordinate legal defense activities, including attorney selection, investigation support, invoice review, and compliance with client guidelines.
- Apply cost containment strategies and investigate fraud, subrogation, contribution, recovery, and case management opportunities.
- Represent the organization in depositions, mediations, and trial monitoring as required.
- Communicate with clients, maintain documented claim files and accurate coding, and escalate cases when appropriate.
- Delegate responsibilities and mentor assigned team members.
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