Liability Claims Adjuster III - Medical Malpractice

Summary

This is a dynamic claims and account management position. In accordance with applicable statutes and in keeping with company rules, regulations, client guidelines and established performance objectives, this role is responsible for effectively managing to conclusion an assigned inventory of medical professional and general liability claim files that may include cases of extreme complexity or with unique or unusual issues.

Culture

Culture – Every member of the Intercare team is responsible for nurturing and promoting a healthy culture. Our culture is the most important element of our success. Intercare’s culture is defined by our Core Values: INTEGRITY: Reinforces our commitment to transparency COLLABORATION: Strengthens our passion for customer service ACCOUNTABILITY: Supports our actions RESPECT: Inspires us to do the right thing EXCELLENCE: Drives our outcomes

Claims Management

• Aid in team building ideas and events
• Lead by example and through service
• Develop and maintain strong and collaborative client relationships
• Establish prompt contact on all new losses within 24 hours of receipt of the claim, including the insured, claimant, or claimant representative, to document relevant facts surrounding the incident and obtain information relevant to analysis of liability and damages
• Thoroughly and accurately evaluate coverage on a timely basis, document coverage analysis, identify coverage issues and draft appropriate coverage letters
• Thoroughly and accurately investigate all claims and document ongoing case facts and relevant information necessary for establishing liability and damages. Perform and document ongoing analysis and evaluation and what is being done to move the case toward closure
• Litigation management – Direct, manage and control the litigation process for nationwide programs
• Assure that all assigned claims are maintained on an active 30–45-day diary and have an up-to-date plan of action outlining activities and actions anticipated for ultimately resolving the claim
• Obtain consultant and/or expert reviews for early evaluation
• Aggressively pursue contribution on multiple defendant cases or where provided by employment or independent contractor agreements and apportionment when there is shared liability
• Assure that the claim file is handled in accordance with applicable statutes, in-force service contracts and company guidelines
• Establish, monitor and adjust claim reserves in strict accordance with assigned authority levels and client claim-handling instructions
• Exhibit and maintain a courteous and helpful attitude and project a professional image on behalf of the company and client
• Respond to telephone messages and inquiries within 24 hours of receipt and to written inquiries within one week of receipt
• Travel for mediations, trials, client meetings and/or industry-related conferences

Qualification Requirements

• To perform this job successfully, an individual must, at a minimum, be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Education and/or Experience: JD and/or RN preferred. Bachelor’s degree from a four-year college or university; at least seven years of related experience and/or training; or an equivalent combination of education and experience.
• Requires a high degree of claims handling expertise, including at least five years managing medical professional liability cases, many with complex litigation or high potential value.

Competency

• An open mind, eagerness to learn, positive attitude and healthy curiosity
• Strong communication skills, including being open and respectful of everyone, regardless of their position or role
• Flexibility and the ability to adapt to change quickly, including switching efficiently between program needs and personalities multiple times throughout the day
• Problem solving, change and conflict management, including developing workable implementation plans and recommendations, communicating changes effectively, building commitment, overcoming resistance and supporting those affected
• Leadership by example and service, including instilling confidence in yourself and others, inspiring and motivating others to perform well ethically, positively influencing others, inspiring respect and trust, accepting and growing from feedback, providing vision and inspiration, recognizing others appropriately, displaying passion and optimism, and mobilizing others to fulfill the vision
• Exceptional customer service, always going above and beyond, searching for ways to expand services, soliciting client feedback, promptly responding to requests and ensuring compliance with client contracts and service instructions
• Strong business acumen, being well spoken, poised, presenting with balanced confidence and humility, taking initiative, sparking innovation, understanding business implications, displaying profitability orientation, knowing the market and aligning work with strategic goals
• Discipline in all aspects of the position with a focus on accuracy, thoroughness and continuous improvement
• Project management skills, including developing plans, coordinating projects, staying on task, communicating changes and completing projects on time and within budget

Physical Demands

• The physical demands described here are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.
• Regularly required to sit
• Frequently required to use hands to finger, handle, feel, type, collate, file or lift
• Some lifting may exceed 10 pounds, such as luggage, collateral materials or claim files
• Required to stand and walk

Work Environment

• The work environment characteristics described here are representative of those encountered while performing essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.
• The noise level in the work environment is usually moderate.
• Powered by JazzHR Y6K6AKL0wK