Senior Claims Specialist, Medical Malpractice – Professional Liability

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

📋 Description

• Evaluate intricate or technically challenging medical malpractice claims

• Provide solutions for highly complex and/or severe injury claims

• Oversee case management in accordance with company standards, industry best practices, and client service expectations

• Manage overall claim expenses while delivering exceptional customer service

• Investigate and collect information to assess claim exposure

• Navigate claims through action plans to ensure timely resolution

• Conduct or delegate investigations and report on new events, claims, and legal actions

• Calculate, assign, and monitor claim reserves

• Suggest settlement strategies and create structured settlement proposals

• Coordinate legal defense, assign attorneys, review attorney invoices, and ensure compliance from counsel

• Implement cost containment strategies and leverage strategic vendor partnerships

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

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

• Communicate claim status and processing with clients while maintaining professional relationships

• Ensure claim files are properly documented and coding is accurate

• Refer cases to supervisors and management as needed

• Support the organization's quality initiatives

• Carry out other responsibilities as assigned

⛳️ Requirements

• 6 years of experience in claims management or a suitable combination of education and experience required

• Bachelor's degree from an accredited institution preferred

• Required licenses as applicable

• Professional certification relevant to the line of business preferred

• Strong analytical and negotiation abilities

• Sound judgment and discretion in decision-making

• Capability to deliver prompt, cost-effective claim resolutions

• Ability to uphold a high standard of customer service

• Clear and conceptual thinking skills

• Ability to meet deadlines consistently

• Proficient in computer keyboarding

• Capable of hearing, vision, and verbal communication

🏝️ Benefits

• Work-life balance

• Caring culture

• Opportunities for professional development and career advancement

• Equal Opportunity Employer

• Drug-Free Workplace