- Career Level
- Experienced (Non-Manager)
Our client is currently seeking a Claims Specialist to handle professional liability claims for all product lines.
- Working under the general supervision of the senior claims leader and acting within authority appropriate for this position, the claims handler is expected to:
- The primary responsibilities of this position are to investigate, evaluate and resolve medical claims. The position requires handling claims across varied medical specialties.
- Conducts investigations to gather evidence and facts sufficient to make appropriate decisions including obtaining review of medical records and expert opinions.
- Reviews coverage and seeks consultation on coverage issues; evaluate liability and damages; determines appropriate course of action for case resolution. Makes decisions and takes action within authority.
- Obtains written consent from insureds; negotiates settlements; utilizes appropriate methods, such as mediation, ADR, and structured settlements.
- Evaluates reserves per company guidelines.
- Secures satisfactory results and timely closures.
- Works closely with defense counsel to establish litigation plan of actions and budgets.
- Presents claims at internal claim roundtables.
- Attending mediations, court conference and trials.
Should possess strong knowledge of relevant legal decisions, claim trends and industry practices
- 5-10 years medical malpractice or equivalent claims experience.
- Proficiency with Excel, Word and demonstrated aptitude with Windows based operating systems
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