Complex Litigation Claims Adjuster II

Overview

Presbyterian is seeking a Complex Litigation Claims Adjuster II that investigates, evaluates, and negotiates more severe and complex claims and litigation to a successful resolution and in compliance with company standards. This position will have a strong background in the claims / litigation process and familiarity with all lines of PHS insurance / claim types. The complex litigation claims adjuster must demonstrate strategic thinking and sound decision-making. Claim types include primarily medical malpractice but may include such claims as Directors and Officers, general and premises liability, property damage exposures of a more severe and complex nature. Maintains claims database documentation, appropriate reserving and case strategy. At the direction of the risk director and risk attorney, directs PHS participation in defense of claims and litigation. Experience managing and resolving high severity injury claims and litigation, proven skills in time management and caseload management, and must be able to document claim files by accurately capturing and updating claims data / information in compliance with best practices. Provide general assistance and support to risk management and legal activities.

Responsibilities

• Manage claims and litigation matters from inception to closure including identification and investigation of coverage, liability and damages issues.
• Manage highly complex high exposure liability claims and litigation involving medical malpractice, bodily injury, property damage, personal injury, and advertising injury.
• Establish and execute appropriate and economical plan for claim resolution in compliance with department / carrier best practices and guidelines.
• Review, analyze, research, and prepare responses for discovery.
• Gather, organize and index requested documents including electronic discovery for interrogatories, requests for production, subpoena, and motions.
• Draft frequent and complex claim related correspondence.
• Prepare claim reports and educates organization about risk issues identified through claims data.
• Attend and participate in settlement negotiations and negotiates within authority; attends mediation and trials related to claims or litigation.
• Manage relationships and provides support for internal and external customers.
• Serve as primary source of contact and support for employees named or involved in claims / lawsuits.
• Consistently demonstrate comprehensive coverage analysis, investigation, evaluation, negotiation skills at an advanced level.
• Direct and control activities of outside vendors, including defense counsel and experts.
• Other duties as assigned.

Qualifications

Benefits

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness

Presbyterian\'s Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

About Presbyterian Healthcare Services

Presbyterian exists to ensure the patients, members and communities we serve can achieve their best health. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state\'s largest private employer with nearly 14,000 employees.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA / EOE / VET / DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Maximum Offer for this position is up to USD $49.26 / Hr.

J-18808-Ljbffr