Medical Malpractice Claim Specialist

Healthcare Risk Advisors is seeking a medical malpractice Claims Specialist to join our claims team. This is a hybrid opportunity based out of New York City.

This position is responsible for performing investigations, evaluations, negotiations, and settlements to equitably resolve claims.

Position conducts business with policyholders and others in a manner that achieves economy and upholds the company’s reputation for quality service.

This position has contacts with employees, vendors, lawyers, and policyholders. This position works under immediate supervision.

Qualifications :

• Minimum of 5-10 years of related medical malpractice experience.
• 2 years professional liability claims and claims management experience preferred.
• JD degree preferred.
• Excellent interpersonal and organizational skills.
• Strong knowledge of medical malpractice law.
• Strong listening skills.
• Strong negotiating skills.
• Strong Microsoft Office Suite skills.

Salary Range : $122,318 - $178,297

Responsibilities :

Service / Support Delivery

• Provides clear communication to client and follows up as necessary based on expectations agreed to with the client.
• Maintains awareness of client’s needs and context of their communication in order to provide proper support.
• Elevates concerns expressed by the insured client to management as necessary.
• Provides excellent service to team members who submit requests to the team.
• Provides high-quality, comprehensive work product that facilitates efficient / effective downstream workflow.
• Identify and elevate ERM exposure.

Claim Guidelines

• Adhere to best practices.
• Understands the venues, applicable law and reserving philosophy of HRA to properly evaluate the exposures contained within the assigned caseload.
• Ensures effective documentation of established reserves.

Claims Investigation / Analysis

• Provides timely analysis of cases to establish appropriate reserves.
• Escalate cases that are unique or unusual to leadership for evaluation, escalation, and communication as necessary.
• Determines the proper course of resolution based on the directed investigation by assigned staff and makes recommendations to leadership accordingly.
• Gives appropriate insight and advice to clients, staff and defense counsel on the best possible outcome for both the insured client and the company.
• Completes coverage analysis and requests coverage review as appropriate.
• Makes appropriate and decisive decisions to establish a plan of action on all cases assigned to the team.
• Directs all reporting to High Exposure Committee and Reinsurers as necessary.

Litigation Management & Claims Resolution

• Makes recommendation for assignment of litigated matters to appropriate defense panel members based on ability and experience.
• Partners with defense counsel for optimum outcome on all assigned cases.
• Monitors and approves fees and expenses within authority to comply with company guidelines and state statutory guidelines.
• Attends and monitors (directly or indirectly) settlement conferences, mediations and trials, reports out timely and insightfully, and escalates as needed.
• Evaluates attorney work product / performance and advises supervisor of any need for corrective action or improvement.
• Recommends the proper course of resolution timely to leadership and / or client based on the investigation and discovery.

Technical Knowledge and Professional Development

• Maintain technical knowledge and skills to efficiently and effectively support and advance the department strategic plan and goals.
• Completes any training required to maintain or advance the skills set necessary to reach department and company goals.

Other Duties as Assigned

• Makes oneself available for any and all.
• Accepts delegated tasks readily and completes assigned duties as directed.
30+ days ago