Sr. Claims Specialist - Perm

Melville, NY 11747

Job Category: Insurance Job Number: 134748

Job Title:          Sr. Claims Specialist - Perm

Location:          Melville, New York, US - 11747

Job Type:          Permanent 

Duration:          Permanent 

NOTE: Need medical malpractice or medical liability experience.

Job Description:

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).

NOTE:

  • 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.

Skills:

  • Licenses as required
  • Professional certification as applicable to line of business preferred

Experience:

  • 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

Education:      

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

Reach Out To A Recruiter

Recruiter:             Swetha Archana

Email:                   swethaa@askstaffing.com

Phone:                   678-785-3432

Sourabh Agrawal
Sourcer Specialist

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