Job Title: Complex Claims Consultant (Healthcare)
Job Responsibilities:
- Manage an inventory of highly complex healthcare professional liability claims with large exposures, requiring specialized technical expertise and coordination.
- Ensure exceptional customer service by managing all aspects of the claim, achieving quality and cycle time standards, and responding promptly to inquiries.
- Verify coverage and establish timely and adequate reserves by reviewing policy language and estimating potential claim valuation.
- Lead focused investigations to determine compensability, liability, and covered damages by gathering pertinent information and working with experts as necessary.
- Resolve claims by developing and executing a claim resolution strategy, managing timely reserves, negotiating settlements, and partnering with counsel on complex litigation.
- Establish and manage claim budgets by achieving timely claim resolution, overseeing appropriate resources, and delivering high-quality service efficiently.
- Address subrogation/salvage opportunities or potential fraud by evaluating claim facts and making referrals to appropriate resources.
- Achieve quality standards by managing each claim according to company protocols, ensuring accuracy, timely resolution, and proper documentation.
- Keep leadership informed of significant risks and losses by completing loss summaries and preparing succinct presentations for senior management.
- Maintain subject matter expertise and ensure compliance with regulatory requirements by staying current on insurance laws and regulations.
- Mentor, guide, and train less experienced Claim Professionals.
Education & Experience:
- Bachelor's Degree or equivalent experience required; JD is a plus.
- Minimum of six years of relevant experience, preferably in claim handling or healthcare/medical malpractice litigation.
- Must obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
- Professional designations such as CPCU are a plus.
Salary Information:
- In Chicago/New York/California, the average base pay range for the Complex Claims Specialist role is $113,000 to $160,000, with salary determinations based on work experience, skills, certifications, and location.
- In other jurisdictions, the national base pay range is $72,000 to $141,000 annually, with similar determinants for salary.
- The company offers a comprehensive and competitive benefits package to support employees and their families in achieving physical, financial, emotional, and social wellbeing goals.
The Complex Claims Consultant role at the company involves managing complex healthcare liability claims, ensuring exceptional customer service, and working collaboratively with internal and external partners to resolve claims efficiently. The position requires a strong understanding of professional liability insurance, excellent communication skills, the ability to manage multiple priorities, and a commitment to collaboration and valuing diverse opinions.
