Claims Advisor, Professional Liability – Medical Malpractice

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

📋 Description

• Oversee and manage medical malpractice and professional liability claims.

• Deliver resolutions for highly complex claims, particularly those involving severe injuries.

• Coordinate case management in accordance with company standards, industry best practices, and specific client service needs.

• Control overall claim costs while ensuring exceptional customer service levels.

• Analyze and process intricate or technically challenging liability claims through investigation and information gathering to assess claim exposure.

• Direct claims using well-structured action plans towards timely and appropriate resolutions.

• Conduct or assign a comprehensive investigation and provide detailed reports on investigations related to new events, claims, and legal actions.

• Negotiate claim settlements up to the designated authority level.

• Calculate and assign timely and suitable reserves for claims; monitor reserve sufficiency throughout the claim lifecycle.

• Propose settlement strategies and present structured settlement offers as necessary to optimize settlements.

• Perform coverage analyses and provide opinions as part of the claims process, including all necessary correspondence.

• Facilitate legal defense by assigning attorneys, coordinating investigative support, and reviewing attorney invoices; ensure compliance with client guidelines.

• Employ effective cost containment strategies, including strategic vendor partnerships, to minimize overall claim costs for clients.

• Identify and investigate potential fraud, subrogation, contribution, recovery, and case management opportunities to lower total claim costs.

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

• Communicate claims activity and processing updates to clients; maintain professional relationships with clients.

• Ensure proper documentation of claim files and accurate claims coding.

• Refer cases to supervisors and management as appropriate.

• Delegate tasks and mentor other team members.

⛳️ Requirements

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

• A Master's degree or Juris Doctorate from an accredited college or university is preferred.

• Required licenses as applicable.

• Preferred designations and/or licenses include but are not limited to: Bachelor of Science in Nursing, Legal Nurse Consultant, Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), Associate in Insurance Claims (AIC), and Certified Professional in Health Care Risk Management (CPHRM).

• Extensive knowledge of relevant medical malpractice insurance principles and laws pertinent to the line of business, including recoveries, offsets, deductions, claim durations, cost containment principles, and Social Security application procedures as relevant.

• Comprehensive knowledge 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 proficiency in presentations.

• Proficient in PC usage, particularly with Microsoft Office applications.

• Strong analytical and interpretive abilities.

• Excellent organizational skills.

• Strong negotiation capabilities.

• Good interpersonal skills.

• Ability to thrive in a team-oriented environment.

🏝️ Benefits

• Medical coverage.

• Dental insurance.

• Vision coverage.

• 401k plan with matching contributions.

• Paid time off (PTO).

• Disability and life insurance.

• Employee assistance program.

• Flexible spending or health savings account options.

• Additional voluntary benefits available.