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.
- Follow company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits.
- Ensure exceptional customer service by managing all aspects of the claim, interacting professionally and effectively, achieving quality and cycle time standards, and providing timely updates.
- Verify coverage and establish timely and adequate reserves by reviewing and interpreting policy language, estimating potential claim valuation, and working with counsel.
- Lead focused investigations to determine compensability, liability, and covered damages by gathering pertinent information, taking recorded statements, and working with experts.
- Resolve claims by collaborating with internal and external business partners to develop, own, and execute a claim resolution strategy, including managing timely and adequate reserves.
- Establish and manage claim budgets by achieving timely claim resolution, overseeing appropriate resources, and authorizing expense payments.
- Address subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate resources for further investigation.
- Achieve quality standards by managing each claim to ensure that all company protocols are followed, work is accurate and timely, and claims are resolved and paid timely.
- Keep leadership informed of significant risks and losses by completing loss summaries, identifying claims for oversight/watch lists, and preparing summaries for senior management.
- Maintain subject matter expertise and ensure compliance with state/local regulatory requirements by following company guidelines.
- Mentor, guide, develop, and deliver training to less experienced Claim Professionals.
Education and Experience:
- Bachelor's Degree or equivalent experience is required; JD is a plus.
- Typically a minimum of six years of relevant experience, 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.
- In certain jurisdictions, including District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York, and Washington, the national base pay range is $72,000 to $141,000 annually.
- Salary determinations are based on various factors, including relevant work experience, skills, certifications, and location.
- Company offers a comprehensive and competitive benefits package to help employees and their family members achieve physical, financial, emotional, and social wellbeing goals.
Note: The company is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process.
