Senior Claims Specialist, Professional Liability – Medical Malpractice

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

📋 Description

• Evaluate intricate or technically challenging medical malpractice claims

• Facilitate the resolution of highly complex and/or severe injury claims

• Oversee case management in alignment with Company standards, industry best practices, and client service expectations

• Manage overall claim costs while ensuring exceptional levels of customer service

• Investigate and collect information to assess claim exposure

• Direct claims through action plans to ensure timely resolution

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

• Calculate and allocate reserves and monitor the adequacy of those reserves

• Suggest settlement strategies and present structured settlement proposals as required

• Coordinate legal defense, appoint attorneys, assist investigations, review attorney invoices, and ensure compliance with counsel

• Employ cost containment strategies and leverage strategic vendor partnerships

• Investigate 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 with clients, maintaining professional relationships

• Ensure claim files are thoroughly documented and claims coding is accurate

• Refer cases to supervisors and management when appropriate

• Support the organization's quality program(s)

• Perform additional duties as assigned

⛳️ Requirements

• A 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

• Strong analytical and negotiation abilities

• Excellent judgment

• Capability to deliver timely and cost-effective claim resolutions

• Exceptional judgment and discretion

• Proficiency in meeting deadlines

• Clear and conceptual thinking capacity

• Computer keyboarding skills

• Adequate hearing, vision, and verbal communication abilities

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• 401k with matching contributions

• Paid Time Off (PTO)

• Disability insurance

• Life insurance

• Employee assistance programs

• Flexible spending or health savings accounts

• Additional voluntary benefits

• Promotion of work-life balance

• Supportive culture

• Commitment to diversity, equity, and inclusion in the workplace