Claim Consultant – Medical Professional Liability

This is a fully remote position, open to applicants in United States.

📋 Description

• Investigate, assess, and resolve MPL and General Liability claims of various complexities and severities.

• Independently provide comprehensive claim loss services to policyholders.

• Conduct interviews with insured individuals, claimants, witnesses, and other relevant parties to evaluate liability exposure.

• Document the findings of investigations and negotiations in the respective files.

• Prepare reports based on established diary dates and other specific requirements.

• Gather records necessary for investigation and case evaluation.

• Formulate and execute negotiation strategies, negotiating settlements within the set authority limits.

• Adjust reserves and recommend reserve amounts exceeding authority limits.

• Keep the Claim Director and/or S.V.P. of Claims informed about claim statuses and attend Reserve & Settlement Committee Meetings as needed.

• Collaborate with other departments to facilitate and coordinate services for insured clients.

• Assess cases for resolution and seek settlement authority when necessary.

• Oversee and guide defense counsel activities in accordance with Case Management Guidelines.

• Monitor trials and participate in pre-trial proceedings, mediations, and arbitrations as required.

• Recognize significant Risk Management or Underwriting concerns and relay information to the appropriate department.

• Communicate effectively with insureds, claimants, and witnesses, consulting medical and other pertinent records.

• Analyze and confirm insurance coverage.

• Maintain an updated understanding of policy forms and verify the policy in effect as of the date of loss.

⛳️ Requirements

• Bachelor’s degree from a four-year college or university.

• R.N. or J.D. is preferred.

• 3-5 years of experience in clinical nursing and/or 3-5 years of claims experience involving severe bodily injury.

• Knowledge of medical, legal, and insurance terminology is essential.

• A current driver's license is required.

• Strong written and verbal communication skills.

• Training in contract/policy review and application is necessary.

• Must be comfortable delivering oral presentations to staff and insured individuals.

• Ability to synthesize complex or diverse information; gather and research data; utilize intuition and experience to enhance data; design workflows and procedures.

• Capable of creating and generating innovative solutions.

• An insurance adjuster’s license may be required for certain states.

• Willingness to travel 25-30% is required.

🏝️ Benefits

• Ability to travel 25-30% is required.