Medical Malpractice Claims Adjuster III

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

📋 Description

• Foster a culture characterized by positivity, respect, support, collaboration, patience, accountability, and excellence.

• Contribute ideas and organize events for team building.

• Demonstrate leadership through exemplary service.

• Build and maintain strong, collaborative relationships with clients.

• Ensure prompt communication regarding all new claims within 24 hours of receipt, including reaching out to the insured, claimant, or claimant representative to gather relevant details related to the incident and information necessary for assessing liability and damages.

• Conduct thorough and timely evaluations of coverage, document coverage analyses, identify coverage issues, and draft appropriate coverage letters.

• Investigate all claims meticulously and document ongoing case facts and pertinent information essential for determining liability and damages; perform continuous analysis and evaluation, and record actions taken to progress the case toward resolution.

• Manage litigation effectively by directing, overseeing, and controlling the litigation process for nationwide programs.

• Ensure that all assigned claims are actively maintained on a 30 to 45-day diary, supported by an up-to-date action plan outlining anticipated activities for resolving the claim.

• Obtain consultant or expert reviews for early case evaluation.

• Actively pursue contributions in multi-defendant cases or as stipulated by employment or independent contractor agreements, managing apportionment in scenarios of shared liability.

• Ensure compliance with applicable statutes, enforceable service contracts, and company guidelines while handling claim files.

• Establish, monitor, and adjust claim reserves in strict adherence to assigned authority levels and client-specific claim handling instructions.

• Maintain a courteous and helpful demeanor, projecting a professional image on behalf of both the company and the client.

• Respond to telephone messages and inquiries within 24 hours and to written inquiries within one week of receipt.

• Travel for mediations, trials, client meetings, and/or industry-related conferences.

• Possess a working knowledge of medical terminology and various jurisdictional issues.

• Perform additional duties and tasks as assigned by the Supervisor or Manager.

⛳️ Requirements

• JD and/or RN preferred.

• Bachelor's degree from an accredited four-year college or university.

• A minimum of seven years of related experience and/or training, or an equivalent combination of education and experience.

• Requires a high level of expertise in claims handling, specifically a minimum of five years managing medical professional liability cases, many involving complex litigation or high potential value.

• Proficient in reading, analyzing, and interpreting insurance policies, statutes, legal opinions, general business periodicals, professional journals, technical procedures, and governmental regulations.

• Capable of writing complex coverage letters, reports, business correspondence, procedure manuals, and communications to clients, colleagues, and industry peers.

• Able to effectively present information both verbally and in writing, and respond to inquiries from groups of managers, clients, customers, and the general public.

• Fluent spoken and written English is required.

🏝️ Benefits

• Comprehensive medical, dental, and vision benefits.

• Company contributions to HSA and FSA plans.

• Employer-paid life and disability insurance.

• 401(k) with company matching contributions.

• Paid time off (PTO) and company-paid holidays.

• Opportunities for learning and development that foster genuine career advancement.

• Employee assistance resources and a supportive culture prioritizing balance and well-being.