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. This involves verifying policy coverage, conducting investigations, developing resolution strategies, and authorizing disbursements within authority limits.
- Ensure exceptional customer service by managing all aspects of the claim process, including professional interactions, achieving quality and cycle time standards, providing timely updates, and promptly responding to inquiries and requests for information.
- Verify coverage and establish timely and adequate reserves by reviewing and interpreting policy language, estimating potential claim valuation, working with counsel, and following company claim handling protocols.
- Lead focused investigations to determine compensability, liability, and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, and witnesses, and working with experts or other parties as necessary to verify the facts of the claim.
- Resolve claims by collaborating with internal and external business partners to develop, own, and execute a claim resolution strategy. This includes managing timely and adequate reserves, collaborating with coverage experts where necessary, negotiating complex settlements, partnering with counsel to manage complex litigation, and authorizing payments within the scope of authority.
- Establish and manage claim budgets by achieving timely claim resolution, selecting and actively overseeing appropriate resources, authorizing expense payments, and delivering high-quality service efficiently.
- Identify and address subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Claim, Recovery, or SIU resources for further investigation.
- Achieve quality standards by appropriately managing each claim to ensure that all company protocols are followed, work is accurate and timely, all files are properly documented, and claims are resolved and paid timely.
- Keep leadership informed of significant risks and losses by completing loss summaries, identifying claims to include on oversight/watch lists, and preparing and presenting succinct summaries to senior management.
- Maintain subject matter expertise and ensure compliance with state/local regulatory requirements by following company guidelines and staying current on commercial insurance laws, regulations, or trends for the line of business.
- Mentor, guide, develop, and deliver training to less experienced Claim Professionals.
- May perform additional duties as assigned.
Education and Experience:
- Bachelor's Degree or equivalent experience required. A JD is considered a plus.
- Typically, a minimum of six years of relevant experience is required, 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 considered a plus.
Salary Information:
- In Chicago, New York, and California, the average base pay range for the Complex Claims Consultant 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, such as 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. Salary determinations are based on various factors, including relevant work experience, skills, certifications, and location.
- The company offers a comprehensive and competitive benefits package to help employees and their family members achieve their physical, financial, emotional, and social well-being goals.
Additional Information:
- The role is available in any location near a company office and offers a flexible, hybrid work schedule.
- Reporting Relationship: Typically Director or above.
- Skills, Knowledge & Abilities required include a thorough knowledge of the professional liability insurance industry, products, policy language, coverage, and claim practices, with an understanding of dental malpractice claims and policies strongly favored. The role also requires strong communication and presentation skills, both verbal and written, analytical and investigative mindset, strong work ethic, time management, organizational skills, ability to negotiate complex settlements, and proficiency in Microsoft Office Suite and business-related software.
- A commitment to collaboration and valuing diverse opinions and ideas is essential.
- The company is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process.
