Job Title: Complex Claims Consultant (Healthcare)
Job Responsibilities:
The Complex Claims Consultant in Healthcare at the company is responsible for the investigation, management, and resolution of healthcare professional liability claims across multiple states. The role is recognized as a technical expert in interpreting complex or unusual policy coverages. Key responsibilities include:
- Managing an inventory of highly complex healthcare professional liability claims with large exposures, requiring specialized technical expertise and coordination. This involves verifying policy coverage, conducting investigations, developing resolution strategies, and authorizing disbursements within authority limits.
- Ensuring exceptional customer service by managing all aspects of the claim, interacting professionally, achieving quality and cycle time standards, and providing timely updates.
- Verifying coverage and establishing timely and adequate reserves by reviewing and interpreting 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.
- Resolving claims by collaborating with internal and external business partners to develop and execute a claim resolution strategy, managing reserves, negotiating settlements, and partnering with counsel to manage litigation.
- Establishing and managing claim budgets by achieving timely claim resolution, overseeing appropriate resources, authorizing expense payments, and delivering high-quality service efficiently.
- Identifying subrogation, salvage opportunities, or potential fraud occurrences by evaluating the facts of the claim and making referrals for further investigation.
- Achieving quality standards by managing each claim to ensure protocols are followed, work is accurate and timely, and claims are resolved and paid promptly.
- Keeping leadership informed of significant risks and losses by completing loss summaries, identifying claims for oversight lists, and preparing summaries for senior management.
- Maintaining subject matter expertise and ensuring compliance with regulatory requirements by following company guidelines and staying current on relevant laws and trends.
- Mentoring, guiding, developing, and delivering training to less experienced claim professionals.
Education and Experience:
- A Bachelor's Degree or equivalent experience is required, with a JD being 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 considered 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, the company is legally required to include a reasonable estimate of the compensation for this role. In states like the 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 support the physical, financial, emotional, and social well-being of employees and their family members.
