Sr. Claims Specialist - Perm
Melville Melville, NY 11747
Job Title: Sr. Claims Specialist - Perm
Location: Melville, New York, US - 11747
Job Type: Permanent
NOTE: Need medical malpractice or medical liability experience.
Position Overview: To analyze complex or technically difficult medical malpractice 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 Functions And Responsibilities:
- Analyzes and processes complex or technically difficult medical malpractice 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.
- 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 assigned staff.
Additional Functions and Responsibilities:
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Credit security clearance, confirmed via a background credit check, is required for this position.
- The statements contained in this document 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.
- Licenses as required
- Professional certification as applicable to line of business preferred
- Seven (7) years of claims management experience or equivalent combination of education and experience required.
Skills & Knowledge:
- 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
- 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
- Bachelor's degree from an accredited college or university preferred
Reach Out To A Recruiter
Recruiter: Swetha Archana