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

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

📋 Description

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

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

• Coordinate case management adhering to company standards, industry best practices, and client service expectations.

• Oversee total claim costs while ensuring exceptional customer service.

• Investigate and collect information to assess claim exposure.

• Manage claims through actionable plans to achieve appropriate and timely resolutions.

• Conduct or assign comprehensive investigations and report on new incidents, claims, and legal matters.

• Calculate and allocate timely and suitable claim reserves; oversee reserve adequacy.

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

• Coordinate legal defense, assign attorneys, assist investigations, review attorney invoices, and ensure compliance from counsel.

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

• Identify and examine opportunities related to fraud, subrogation, contribution, recovery, and case management.

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

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

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

• Refer cases to supervisors and management as deemed appropriate.

• Support the organization's quality initiatives.

• Carry out additional duties as assigned.

⛳️ Requirements

• A minimum of 6 years of claims management experience or a suitable combination of education and experience is required.

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

• Relevant licenses as mandated.

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

• Experience in managing complex medical malpractice claims involving severe injuries and high exposure is essential.

• Strong analytical and negotiation capabilities.

• Excellent judgment.

• Ability to deliver timely, cost-effective resolutions for claims.

• High standard of customer service.

• Capacity for clear and conceptual thinking.

• Exceptional judgment and discretion.

• Ability to meet deadlines effectively.

• Proficiency in computer keyboarding.

• Adequate hearing, vision, and verbal communication skills.

🏝️ 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 culture.

• Opportunities for professional growth and career development.