Senior Claims Specialist, Medical Malpractice – Professional Liability

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

📋 Description

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

• Conduct investigations and collect information to assess claim exposure.

• Oversee claims via strategic action plans to achieve timely and appropriate resolutions.

• Execute or delegate comprehensive investigations and report on emerging events, claims, and legal matters.

• Calculate and assign timely, suitable claim reserves while monitoring reserve sufficiency.

• Suggest settlement strategies and present structured settlement proposals when required.

• Coordinate legal defenses, appoint attorneys, assist with investigations, review attorney bills, and ensure compliance with client guidelines.

• Implement cost-containment measures and foster strategic vendor partnerships to lower client claim expenses.

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

• Represent the organization in depositions, mediations, and trial observations as necessary.

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

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

• Refer cases to supervisors and management as deemed appropriate.

• Contribute to the organization's quality initiatives.

• Perform other assigned responsibilities.

⛳️ Requirements

• A minimum of 6 years in claims management or an equivalent combination of education and experience.

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

• Required licenses as applicable.

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

• Proficiency in computer keyboarding.

• Ability to hear, see, and speak.

• Capacity for clear and conceptual thinking.

• Exceptional judgment and discretion.

• Capability to meet deadlines effectively.

• Strong analytical and negotiation skills.

• Sound decision-making abilities.

• Dedication to timely, cost-effective claim resolutions and exemplary customer service.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• 401(k) plan with matching contributions.

• Paid time off (PTO).

• Disability insurance.

• Life insurance.

• Employee assistance program.

• Flexible spending account or health savings account.

• Additional voluntary benefits.

• Work-life balance.

• Supportive company culture.