Senior Claims Specialist, Professional Liability

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

📋 Description

• Evaluates and processes intricate or technically challenging medical malpractice claims by investigating and collecting information to assess the claim's exposure.

• Oversees claims using well-structured action plans to achieve timely and appropriate resolutions.

• Conducts or assigns comprehensive investigations and provides reports related to new incidents, claims, and legal actions.

• Negotiates claim settlements up to the designated authority level.

• Accurately calculates and assigns timely reserves to claims while monitoring reserve adequacy throughout the duration of the claim.

• Suggests settlement strategies and presents structured settlement proposals as necessary to optimize settlement outcomes.

• Coordinates legal defense by assigning an attorney, facilitating investigation support, and reviewing attorney invoices; ensures compliance with client guidelines by monitoring counsel.

• Implements cost containment strategies, including strategic partnerships with vendors, to minimize overall claim costs for our clients.

• Identifies and investigates potential fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim expenses.

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

• Maintains communication regarding claim activities and processing with clients while fostering professional client relationships.

• Ensures that claim files are accurately documented and that claims coding is precise.

• Refers cases as necessary to supervisors and management.

• Delegates tasks and mentors assigned staff.

⛳️ Requirements

• Preferred: Bachelor's degree from an accredited college or university.

• Licenses as required.

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

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

• Thorough understanding of relevant medical malpractice insurance principles and laws for the specific line of business handled.

• Outstanding oral and written communication skills, including proficiency in presentations.

• Proficient with PC applications, including Microsoft Office Suite.

• Strong analytical and interpretive abilities.

• Excellent organizational capabilities.

• Highly effective negotiation skills.

• Strong interpersonal skills.

• Capability to work collaboratively in a team environment.

• Ability to meet or exceed performance competencies.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• 401(k) plan with matching contributions.

• Paid Time Off (PTO).

• Disability and life insurance.

• Employee assistance programs.

• Flexible spending or health savings accounts.

• Additional voluntary benefits available.