Job Title: Complex Claims Consultant - Healthcare
Job Responsibilities:
The Complex Claims Consultant in Healthcare is responsible for managing and resolving healthcare professional liability claims across multiple states. This role involves:
- Managing an inventory of highly complex healthcare professional liability claims with large exposures, requiring specialized technical expertise and coordination.
- Ensuring exceptional customer service by managing all claim aspects, interacting professionally, achieving quality and cycle time standards, and providing timely updates.
- Verifying coverage and establishing timely and adequate reserves by reviewing policy language, estimating claim valuation, and working with counsel.
- Leading investigations to determine compensability, liability, and covered damages by gathering information, taking recorded statements, and working with experts.
- Resolving claims by collaborating with business partners to develop and execute a claim resolution strategy, negotiating complex settlements, and managing litigation.
- Establishing and managing claim budgets by achieving timely resolution, overseeing resources, and authorizing expense payments.
- Addressing subrogation/salvage opportunities or potential fraud by evaluating claim facts and making referrals for further investigation.
- Achieving quality standards by managing claims to ensure protocol compliance, accuracy, proper documentation, and timely resolution and payment.
- Keeping leadership informed of significant risks and losses by completing loss summaries and preparing presentations for senior management.
- Maintaining subject matter expertise and ensuring compliance with regulatory requirements by following guidelines and staying current on insurance laws and trends.
- Mentoring and training less experienced Claim Professionals.
Education & Experience:
- Bachelor's Degree or equivalent experience; a JD is a plus.
- Typically a minimum of six years of relevant experience, preferably in claim handling or medical malpractice litigation.
- Must have or be able to 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, and California, the average base pay range for this role is $113,000 to $160,000. Salary determinations are based on relevant work experience, skills, certifications, and location. In certain jurisdictions, the national base pay range is $72,000 to $141,000 annually. Company offers a comprehensive and competitive benefits package to help employees and their families achieve physical, financial, emotional, and social wellbeing goals.
The position enjoys a flexible, hybrid work schedule and is available in any location near a company office.
