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Medical Malpractice Claims Specialist
2 months ago
We are seeking a highly skilled Medical Malpractice Claims Specialist to join our team at ICONMA. As a key member of our claims team, you will be responsible for analyzing and processing complex medical malpractice claims, providing resolution of highly complex nature and/or severe injury claims, and managing the total claim costs while providing high levels of customer service.
Key Responsibilities- Analyze and process complex medical malpractice claims by investigating and gathering information to determine the exposure on the claim.
- Manage claims through well-developed action plans to an appropriate and timely resolution.
- Conduct or assign full investigation and provide report of investigation pertaining to new events, claims, and legal actions.
- Negotiate claim settlement up to designated authority level.
- Calculate and assign timely and appropriate reserves to claims; monitor reserve adequacy throughout claim life.
- Recommend settlement strategies; bring structured settlement proposals as necessary to maximize settlement.
- Perform coverage analysis and opinion as part of the claim process including all necessary correspondence.
- Coordinate legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitor counsel for compliance with client guidelines.
- Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.
- Identify and investigate for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
- Represent company in depositions, mediations, and trial monitoring as needed.
- Communicate claim activity and processing with the client; maintain professional client relationships.
- Ensure claim files are properly documented and claims coding is correct.
- Refer cases as appropriate to supervisor and management.
- Delegate work and mentor others.
- Bachelor's degree from an accredited college or university required.
- Professional certification as applicable to line of business preferred.
- Six (6) years of medical malpractice claims management experience or equivalent combination of education and experience preferred.
- 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.
- Claims expertise in medical malpractice.
- 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.
As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or expression, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.
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