Senior Claims Specialist, Medical Malpractice

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

📋 Description

• Evaluate and manage complex or technically challenging medical malpractice claims.

• Conduct investigations and collect information to ascertain claim exposure.

• Oversee claims utilizing action plans to ensure timely and appropriate resolutions.

• Perform or assign investigations and compile investigation reports.

• Negotiate claim settlements within the designated authority limits.

• Calculate, assign, and oversee claim reserves.

• Propose settlement strategies and create structured settlement plans.

• Coordinate legal defense efforts, assign attorneys, support investigations, and review attorney invoices.

• Ensure compliance of counsel with client guidelines.

• Implement cost containment strategies and foster strategic vendor partnerships.

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

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

• Communicate claim activities and processing updates to clients.

• Maintain professional relationships with clients.

• Ensure claim files are properly documented and claims coding is accurate.

• Refer cases to supervisors and management when appropriate.

• Delegate tasks and mentor assigned staff members.

• Contribute to the organization's quality programs.

• Perform additional duties as assigned.

⛳️ Requirements

• A bachelor's degree from an accredited college or university is preferred.

• Licenses as required by the position.

• Professional certification relevant to the line of business is preferred.

• A minimum of six (6) years of claims management experience or an equivalent combination of education and experience is required.

• Comprehensive knowledge of pertinent medical malpractice insurance principles and regulations.

• Familiarity with recoveries, offsets and deductions, claim and disability duration, and cost containment principles.

• Understanding of medical management practices and Social Security application procedures as applicable.

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

• Proficient in PC use, including Microsoft Office applications.

• Strong analytical and interpretive abilities.

• Excellent organizational skills.

• Outstanding negotiation skills.

• Strong interpersonal skills.

• Ability to work collaboratively within a team environment.

• Ability to meet or exceed established Performance Competencies.

• A confirmed credit security clearance through a background credit check is mandatory.

🏝️ 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 options.

• Additional voluntary benefits available.

• Reasonable accommodations provided when applicable and appropriate.