Claims Advisor, Professional Liability – Medical Malpractice

This is a fully remote position, open to applicants in New York.

📋 Description

• Oversee and manage medical malpractice and professional liability claims.

• Address highly complex and/or severe injury claims.

• Coordinate case management in alignment with company standards, industry best practices, and client service expectations.

• Manage overall claim costs while ensuring exceptional customer service.

• Analyze and process intricate or technically challenging liability claims by investigating and collecting information to assess exposure.

• Guide claims through action plans to achieve timely resolutions.

• Conduct or delegate comprehensive investigations and provide investigation reports for new incidents, claims, and legal matters.

• Negotiate claim settlements up to the established authority level.

• Calculate, assign, and track appropriate claim reserves.

• Suggest settlement strategies and present structured settlement proposals as necessary.

• Perform coverage analysis and provide opinions, including necessary correspondence.

• Coordinate legal defense, assign attorneys, assist with investigations, and review attorney invoices.

• Monitor attorney compliance with client guidelines.

• Implement cost containment strategies and strategic vendor partnerships to minimize claim costs.

• Investigate potential fraud, subrogation, contribution, recovery, and case management opportunities.

• Represent the company in depositions, mediations, and trial monitoring as required.

• Communicate claim activities and processing details with clients while maintaining professional relationships.

• Ensure claim files are accurately documented and coding is correct.

• Refer cases to supervisors and management when appropriate.

• Delegate tasks and provide mentorship to others.

⛳️ Requirements

• A minimum of ten (10) years of experience in complex claims management is required, or an equivalent combination of education and experience.

• A Master’s or Juris Doctorate degree from an accredited institution is preferred.

• Licenses as mandated.

• Preferred designations/licensing may include Bachelor of Science in Nursing, Legal Nurse Consultant, Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), and Certified Professional in Health Care Risk Management (CPHRM).

• Comprehensive understanding of medical malpractice insurance principles and regulations.

• Knowledge of recoveries, offsets and deductions, claim and disability duration, and cost containment strategies.

• Familiarity with medical management practices and Social Security application procedures as applicable.

• Extensive knowledge and understanding of insurance coverage.

• Claims expertise in medical malpractice, errors and omissions, directors and officers, life sciences, and/or cyber liability.

• Exceptional oral and written communication skills, including presentation abilities.

• Proficient in PC usage, including Microsoft Office applications.

• Strong analytical and interpretive capabilities.

• Excellent organizational skills.

• Outstanding negotiation abilities.

• Effective interpersonal skills.

• Ability to collaborate within a team environment.

• Capacity to meet or surpass Performance Competencies.

• Competence in performing computer keyboarding tasks.

• Adequate hearing, vision, and verbal communication abilities.

• Clear and conceptual thinking capability, excellent judgment and discretion, and ability to adhere to deadlines.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• 401k with matching contributions.

• Paid Time Off (PTO).

• Disability insurance.

• Life insurance.

• Employee assistance program.

• Flexible spending or health savings account.

• Additional voluntary benefits.

• Work-life balance.

• Supportive and caring culture.