Senior Claims Examiner, Medical Malpractice
4 weeks ago
Job Summary:
Responsible for the administration of medical malpractice and other professional and general liabilty claims made during the course of conducting company business across the enterprise, having a material impact on legal reserves that are listed as a separate line item on the companys financial statements. The collective value of claims settled, as influenced by this job function, have direct implications for KPs bottom line. The resolution of these claims can also have ramifications for KPs reputation as well as potential regulatory involvement. Ensure claims are handled appropriately within the National Claims Guidelines and successfully resolved, including retention of outside defense counsel, in-house resolution, monitoring of legal fees, costs and settlement expenses, attendance at court proceedings, provision of claims analysis in leadership committees and identification of insurance coverage applicability.
Essential Responsibilities:
Provides comprehensive support on medical malpractice and related cases and claims brought against Kaiser Permanente. Together with the responsible attorney in the public and professional liability practice group, manages the defense and disposition of professional liability claims and litigation.
Claims Management: Ensures compliance with internal PPL policies for management, handling & reporting of moderately complex to complex claims.
Investigates pre-suit claims related to medical malpractice, professional liability, general liability, coverage/benefit and some business practices and disposition thereof, if appropriate, including selection and retention of medical experts and negotiation with claimants and/or their attorneys.
Updates and maintains claims databases; inputs into national claims-related databases.
Analyzes and prepares responses to discovery requests (including interrogatories and responses to requests for production of documents).
Attends significant depositions, hearings, settlement conferences and trials.
Retains and directs defense counsel in the event that early disposition is not appropriate or possible.
Monitors status of cases and outside counsel compliance with litigation guidelines. Participates with outside counsel in the development of strategic case management and action plan steps.
Keeps KP Lead Claims Counsel updated on all significant matters or legal developments that arise within incumbents claims roster.
Fiscal Management: Sets reserves based upon the total loss exposure and the probabilities of different outcomes for claims disposition. Establishes and conducts quarterly review of reserve information.
Insurance Policy Management: Ensures completion and submission of appropriate reports to Risk Finance on matters of potential Excess Insurer intervention.
Management Reporting: Compiles requested information for management reporting; updates and maintains claims calendar; maintains claim files.
Basic Qualifications:
Experience
Minimum five (5) years of related experience with a commercial professional liability insurer required. The commercial professional liability insurer experience may be substituted for related experience with a self-insured trust, captive insurer, or physician indemnification program, handled either by an internal corporate legal dept, or outside law firm, or equivalent experience.
Education
Bachelors degree in a related field, OR four (4) years directly related experience required.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
N/A
Additional Requirements:
Similar experience with an equivalent self-insured trust, captive insurer, or physician indemnification program will also be considered.
Medical and/ior legal experience.
Effective knowledge and understanding of professional liability claims handling protocols and processes.
Experience working and communicating with senior leadership and ability to present and discuss claims in a formal setting.
Strong computer skills with proficiency in Microsoft Office software.
Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
Seven (7) years of related experience with a commercial professional liability insurer. The commercial professional liability insurer experience may be substituted for related experience with a self-insured trust, captive insurer, or physician indemnification program, handled either by an internal corporate legal dept, or outside law firm, or equivalent experience.
J.D. law degree
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