Sr. Claims Specialist, Medical Malpractice | Professional Liability

Accountabilities • Investigate, analyze, and manage complex or technically difficult medical malpractice claims, gathering relevant information to assess exposure and determine appropriate resolution strategies.

• Develop and execute structured claim action plans to ensure timely, effective, and appropriate outcomes.

• Conduct or assign comprehensive investigations into new incidents, claims, and legal actions, preparing detailed investigation reports.

• Negotiate claim settlements within designated authority limits and recommend appropriate settlement strategies.

• Calculate, establish, and regularly review claim reserves to ensure they remain accurate and adequate throughout the claims lifecycle.

• Evaluate structured settlement opportunities when appropriate to achieve effective claim resolution.

• Coordinate legal defense activities, including attorney selection, investigation support, invoice review, and monitoring compliance with client guidelines.

• Apply cost containment strategies and leverage vendor partnerships to reduce overall claim expenses.

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

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

• Maintain regular communication with clients regarding claim progress, decisions, and processing activities while building strong professional relationships.

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

• Escalate cases to supervisors or management when appropriate.

• Delegate responsibilities and provide mentorship and guidance to assigned team members.

• Support organizational quality initiatives and perform additional duties as assigned.

Requirements:

• At least 6 years of claims management experience, or an equivalent combination of education and professional experience.

• Bachelor's degree from an accredited college or university preferred.

• Relevant professional licenses as required for the role.

• Professional certification applicable to the line of business preferred.

• In-depth knowledge of medical malpractice insurance principles, relevant laws, and professional liability claims practices.

• Understanding of recoveries, offsets, deductions, claim duration, and applicable cost containment strategies.

• Familiarity with medical management practices and related claims procedures.

• Strong investigation, analytical, and interpretive skills, with the ability to assess complex claim information and determine appropriate strategies.

• Excellent oral and written communication skills, including the ability to prepare reports, communicate with clients, and deliver presentations.

• Strong negotiation and interpersonal skills, with the ability to work effectively with clients, attorneys, vendors, and colleagues.

• Excellent organizational skills and the ability to manage multiple priorities, exercise sound judgment, and meet deadlines.

• Proficiency with Microsoft Office and general computer applications.

• Ability to work independently while contributing effectively within a team environment.

• Willingness and ability to travel as required.

Benefits:

• Starting pay: $125,000 for the jurisdiction specified in the original posting. Compensation may vary based on experience, skills, and work location.

• Medical, dental, and vision insurance.

• 401(k) retirement plan with employer matching.

• Paid time off (PTO).

• Disability and life insurance.

• Employee assistance program.

• Flexible spending account (FSA) or health savings account (HSA).

• Additional voluntary benefits.

• Remote work arrangement.

• Reasonable accommodations are considered where applicable and appropriate.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether?

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