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. Recognized as a technical expert, the consultant interprets complex or unusual policy coverages and operates within defined authority limits to handle claims with moderate to high complexity and exposure. Key responsibilities include:
- Managing a portfolio of highly complex healthcare professional liability claims with large exposures, ensuring coordination and adherence to company protocols for verifying policy coverage, conducting investigations, developing resolution strategies, and authorizing disbursements within authority limits.
- Providing exceptional customer service by managing all aspects of the claim, achieving quality and cycle time standards, and responding promptly to inquiries and requests for information.
- Verifying coverage and establishing timely and adequate reserves by reviewing policy language, estimating claim valuation, working with counsel, and following the company's claim handling protocols.
- Leading focused investigations to determine compensability, liability, and covered damages by gathering pertinent information, taking recorded statements, and working with experts as necessary to verify the facts of the claim.
- Resolving claims by collaborating with internal and external business partners to execute a claim resolution strategy, managing reserves, negotiating complex settlements, partnering with counsel on litigation, and authorizing payments within scope of authority.
- 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 by evaluating claim facts and making referrals to appropriate resources for further investigation.
- Maintaining subject matter expertise and ensuring compliance with regulatory requirements by following company guidelines and staying current on insurance laws and trends.
- Mentoring and training less experienced Claim Professionals.
Education & 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 preferred, especially in claim handling or healthcare/medical malpractice litigation.
- The candidate 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 factors such as 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 benefits package to support employees and their family members in achieving their wellbeing goals.
Company is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process.
