Senior Claims Specialist – Professional Liability, Long Term Care, Medical Malpractice

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Analyze intricate or technically challenging medical malpractice claims; provide resolutions for highly complex cases and/or severe injury claims.

• Coordinate case management in alignment with Company standards, industry best practices, and specific client service needs.

• Oversee total claim costs while ensuring exceptional levels of customer service.

• Investigate and process complex or technically challenging medical malpractice and long-term care claims to assess the exposure on each claim.

• Conduct or delegate comprehensive investigations and deliver reports related to new events, claims, and legal actions.

• Calculate and assign timely and appropriate reserves to claims; monitor reserve adequacy throughout the claim lifecycle.

• Propose settlement strategies; present structured settlement proposals as needed to optimize settlements.

• Manage legal defense by assigning attorneys, coordinating investigative support, and reviewing attorney invoices; ensure compliance with client guidelines by monitoring counsel.

• Implement effective cost containment strategies, including strategic vendor partnerships, to minimize overall claim costs for our clients.

• Identify and investigate potential fraud, subrogation, contribution, recovery, and case management opportunities to lower total claim costs.

• Represent the Company in depositions, mediations, and trial monitoring as required.

• Communicate claim activities and processing updates with clients; maintain professional relationships with clients.

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

• Refer cases to supervisors and management as appropriate.

⛳️ Requirements

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

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

• Necessary licenses as required.

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

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunities for career development and advancement.

• A diverse and comprehensive benefits package, including medical, dental, vision, and 401K from day one.