Medical Malpractice Claims Specialist | Remote

Job Description

Job Description

Our client, a well-established insurance carrier specializing in professional liability coverage, is seeking an experienced Medical Malpractice Claims Adjuster to join its Claims team. This individual will independently manage a portfolio of medical malpractice and healthcare professional liability claims from initial notice through final resolution.

The ideal candidate will bring strong technical claims expertise, sound judgment, and experience handling complex and litigated medical malpractice matters. This role requires the ability to conduct thorough investigations, analyze coverage and liability, evaluate claim exposure, and work closely with insureds, defense counsel, medical experts, and other stakeholders to drive effective claim outcomes.

Responsibilities:

• Independently manage medical malpractice and healthcare professional liability claims throughout the full claim lifecycle, from initial reporting through resolution.

• Analyze policy language, coverage provisions, and claim circumstances to identify coverage issues and determine claim applicability.

• Conduct comprehensive claim investigations, including reviewing medical records, legal documentation, expert reports, and other relevant materials.

• Communicate with insureds, claimants, attorneys, medical professionals, expert consultants, and other parties throughout the claim process.

• Evaluate liability, damages, venue, litigation exposure, and overall claim value while developing appropriate resolution strategies.

• Manage complex and litigated claims, including selecting, retaining, and partnering with defense counsel and medical experts.

• Negotiate settlements and pursue timely, cost-effective claim resolutions within assigned authority.

• Draft clear and professional claim correspondence, including coverage determinations, reservation of rights letters, and other coverage-related communications.

• Maintain accurate claim documentation, reserves, action plans, and file updates in accordance with internal standards and regulatory requirements.

• Proactively identify claim trends, emerging exposures, and opportunities to mitigate loss severity.

Qualifications:

• 5+ years of experience handling medical malpractice, healthcare professional liability, or comparable complex professional liability claims.

• Demonstrated experience managing complex and litigated claims from inception through resolution.

• Strong understanding of liability investigations, coverage analysis, policy interpretation, damages evaluation, and litigation management.

• Experience working directly with defense counsel, medical experts, insured healthcare professionals, and other external partners.

• Working knowledge of medical terminology and legal processes related to medical malpractice and professional liability claims.

• Strong negotiation, analytical, organizational, and decision-making skills.

• Excellent written and verbal communication skills, including the ability to prepare professional coverage and claim correspondence.

• Ability to independently manage multiple complex claims, prioritize competing deadlines, and maintain a high level of attention to detail.

• Bachelor’s degree preferred.

• Professional insurance designations such as AIC, CPCU, SCLA, or similar credentials are a plus.

Compensation & Benefits

• Base Salary: $115,000–$125,000, depending on experience

• Comprehensive medical, dental, and vision insurance

• Paid time off

• Paid holidays

• Additional benefits and retirement programs available