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

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

📋 Description

• Evaluate and manage intricate or technically challenging medical malpractice claims, including those related to long-term care facilities.

• Investigate claims and collect information to assess exposure.

• Oversee claims through action plans to ensure timely and suitable resolutions.

• Conduct or delegate comprehensive investigations and provide reports for new incidents, claims, and legal proceedings.

• Calculate and assign timely, appropriate claim reserves while monitoring reserve adequacy.

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

• Coordinate legal defense by assigning attorneys, aiding investigations, reviewing attorney invoices, and ensuring counsel compliance with client guidelines.

• Implement cost containment strategies and develop strategic vendor partnerships to minimize claim costs.

• Identify and investigate potential fraud, subrogation, contribution, recovery, and case management opportunities.

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

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

• Ensure proper documentation of claim files and accuracy in claim coding.

• Refer cases to supervisors and management as necessary.

• Support the organization's quality initiatives.

• Perform other assigned responsibilities.

⛳️ Requirements

• Minimum of 6 years of claims management experience, or a comparable combination of education and experience.

• Bachelor's degree from an accredited institution preferred.

• Licenses as required.

• Professional certification relevant to the line of business preferred.

• Exceptional analytical and negotiation skills.

• Sound judgment and discretion.

• Ability to think clearly and conceptually.

• Excellent decision-making abilities.

• Capacity to meet deadlines.

• Ability to deliver high levels of customer service.

• Proficiency in keyboarding.

• Capable of hearing, vision, and verbal communication.

🏝️ 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.

• Commitment to work-life balance.

• Supportive company culture.

• Equal opportunity workplace.

• Drug-free work environment.