• Bachelor''s Degree required
• MEDMAL practice experience; experience working with MedMal Carriers; MedMal practice as a defense attorney is ideal
• To analyze complex or technically difficult healthcare, environmental, management, executive, cyber, professional liability, error and omissions, and complex liability claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
• Analyzes and processes complex or technically difficult medical professional liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.
• Negotiates claim settlement up to designated authority level.
• Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.
• Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.
• Performs coverage analysis and opinion as part of the claim process including all necessary correspondence.
• Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.
• Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
• Represents company in depositions, mediations, and trial monitoring as needed.
• Communicates claim activity and processing with the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.
• Delegates work and mentors others.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
• Performs other duties as assigned.
• Travels as required.
QUALIFICATIONS
• Education & Licensing
• Bachelor''s degree from an accredited college or university required. Professional certification as applicable to line of business preferred.
• Experience Six (6) years of medical malpractice claims management experience or equivalent combination of education and experience preferred.
Skills & Knowledge
• In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business
• Claims expertise in medical malpractice
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent negotiation skills
• Good interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies
- **Only those lawfully authorized to work in the designated country associated with the position will be considered.**
- **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**
Rose International has been great to me. I thank everyone there for all of their hard work; it has not gone unnoticed.
Melody, Consultant
You are customer service oriented. No matter whether it was the Recruiter or someone in Human Resources/Payroll, you were responsive. That to me is key!
Tonya, Consultant
Working for Rose International was the most pleasant assignment I have ever had. They were always on top of situations when necessary, and very helpful. I was very proud to be an employee of Rose International, and would recommend anyone to try to work with them.
Melvon, Consultant
Rose International was not only attentive and responsive, but they were very professional and helpful whenever I called or needed any assistance.
Diane, Consultant
Any time I did have a question and called, the phone was always answered, and my question/concern was immediately resolved.
Sally, Consultant
EMPLOYEE COMMENTS