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Years of Experience
Date Last Verified
AVP, Healthcare Medical Liability Claims, North American Claims Group The candidate oversees the day to day management of claim staff and the claims they handle. Manages a claim team. Hires and trains claims analysts and associates. Reviews and assigns all new loss notices. Coordinates monthly deductible recovery reconciliation. Provides oversight and mentoring of claims staff. Approves reserves, payments and other actions consistent with authority. Conducts periodic claim file reviews. Provides back-up for claim staff. Manages a reduced case load of claims. Analyzes coverage and manages litigation by effectively interacting with insureds, brokers, defense counsel and other parties as required. Represents company in the resolution of claims and participates in legal proceedings, including mediations. Interacts with underwriters concerning renewals and prospective accounts as well as individual claims and policy issues. Interacts with Legal and Compliance as necessary regarding regulatory issues. Meets with actuaries/F&A as required. Interacts with Claim Operations as necessary regarding enhancements to Claims systems and other operational issues. Prepares periodic reports for management. Meets with existing or prospective clients and brokers. Attends and/or presents at relevant industry conferences/meetings. Prepares for and represents Claims department in internal and external audits. Works with reinsurers as needed.
Qualification and Experience
The candidate should have a Bachelor’s degree; CPCU or J.D. is preferred. 7-10 years’ experience managing a claims department or related relevant experience although experience in handling healthcare claims is preferred. Strong leadership and communication skills with substantial knowledge of national healthcare statutes, law and claim related issues required. Should have excellent negotiation and communication skills including technical writing. Ability to manage internal and external relationships and staff development is needed. Ability to develop and implement departmental policies and procedures, analyze coverage and instruct and collaborate with counsel regarding litigation strategy and claim resolution, and resolve claims and otherwise act within the scope of delegated authority is must. Should have the ability to read, comprehend and analyze written materials quickly and to use a computer for long periods of time. Some travel required, approximately 5-15%.
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