Attorney in Los Angeles, CA

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In-House

Los Angeles, CA

Attorney in Los Angeles, CA

Non-practicing Attorney

Min 6 yrs required

No

Job Title:
Complex Claims Consultant (Healthcare)

Job Responsibilities:
The Complex Claims Consultant in Healthcare at the company is responsible for managing the overall investigation, management, and resolution of healthcare professional liability claims across multiple states. This role requires the consultant to be recognized as a technical expert in interpreting complex or unusual policy coverages. The consultant will work under general management direction within defined authority limits to manage claims with moderate to high complexity and exposure in accordance with company protocols, quality, and customer service standards. Essential duties and responsibilities include:

- 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 aspects of the claim process, interacting professionally, achieving quality and cycle time standards, providing timely updates, and responding promptly to inquiries.
- Verifying coverage and establishing timely and adequate reserves by reviewing policy language, estimating potential claim valuation, and working with counsel.
- Leading focused investigations to determine compensability, liability, and covered damages by gathering pertinent information, taking recorded statements, and working with experts or other parties to verify claim facts.
- Resolving claims by collaborating with internal and external business partners to develop and execute a claim resolution strategy, negotiating complex settlements, and partnering with counsel to manage litigation.
- Establishing and managing claim budgets by achieving timely claim resolutions, selecting and overseeing appropriate resources, and authorizing expense payments.
- Addressing subrogation/salvage opportunities or potential fraud occurrences by evaluating claim facts and making referrals to appropriate resources.
- Achieving quality standards by managing each claim to ensure adherence to company protocols, accurate and timely work, proper documentation, and timely claim resolutions and payments.
- 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 staying current on commercial insurance laws and regulations.
- Mentoring, guiding, and delivering training to less experienced claim professionals.

Education and Experience Information:
- A Bachelor’s Degree or equivalent experience is required; a JD is a plus.
- Typically, a minimum of six years of relevant experience is required, preferably in claim handling or healthcare/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 the Complex Claims Specialist role is $113,000 to $160,000. Salary determinations are based on various factors, including relevant work experience, skills, certifications, and location. In certain jurisdictions like District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York, and Washington, the national base pay range for this job level is $72,000 to $141,000 annually. The company offers a comprehensive and competitive benefits package to help employees and their family members achieve their physical, financial, emotional, and social wellbeing goals.

Jun 19, 2025
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