Claims Advisor, Professional Liability | Medical Malpractice

PRIMARY PURPOSE OF THE ROLE: Manage and handle medical malpractice and professional liability claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service.

ESSENTIAL RESPONSIBILITIES

Analyzes and processes complex or technically difficult liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. Negotiates claim settlement up to designated authority level. Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. Performs coverage analysis and opinion as part of the claim process including all necessary correspondence. Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. Represents company in depositions, mediations, and trial monitoring as needed. Communicates claim activity and processing with the client; maintains professional client relationships. Ensures claim files are properly documented and claims coding is correct. Refers cases as appropriate to supervisor and management. Delegates work and mentors others.

QUALIFICATIONS

Education & Licensing: Ten (10) years of complex claims management experience or equivalent combination of education and experience required. Masters or Juris Doctorate degree from an accredited college or university preferred. Licenses as required. Designations and/or licensing including but not limited to Bachelor of Science in Nursing, Legal Nurse Consultant, Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), Associate in Insurance Claims (AIC), Certified Professional in Health Care Risk Management (CPHRM) preferred.

SKILLS

In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business. Extensive knowledge and comprehension of insurance coverage. Claims expertise in medical malpractice, errors and omissions, directors and officers, life sciences, and/or cyber liability. Excellent oral and written communication, including presentation skills. PC literate, including Microsoft Office products. Analytical and interpretive skills. Strong organizational skills. Excellent negotiation skills. Good interpersonal skills. Ability to work in a team environment. Ability to meet or exceed Performance Competencies.

WORK ENVIRONMENT REQUIREMENTS

Physical: Computer keyboarding. Auditory/visual: Hearing, vision and talking. Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

COMPENSATION & BENEFITS

$100,000 to $125,000. A comprehensive benefits package is offered including but not limited to medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

LEGAL STATEMENTS

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. These statements are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. #J-18808-Ljbffr Sedgwick Law