Sr. Claims Specialist - Perm
Dubuque - IA
$43.27 HOUR USD
Melville NY, 11747
The Sedona Group https://www.sedonacompass.com/images/sqlogo.png https://www.sedonacompass.com/images/sqlogo.png https://www.sedonacompass.com/ 1-888-696-8813 612 Valley View Drive, Moline, IL 61265
Sr. Claims Examiner
Location: Melville, NY
Wage: $90,000 + / year Direct Hire Opportunity
PRIMARY PURPOSE: To analyze complex or technically difficult medical malpractice 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.
What you get to do:
- Analyzes and processes complex or technically difficult medical malpractice 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.
- 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 assigned staff.
What we need from you:
- Seven (7) years of claims management experience or equivalent combination of education and experience required.
- Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
- Licenses as required & Professional certification as applicable to line of business preferred
- 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
- Excellent oral and written communication, including presentation skills
If you are interested in applying for this opportunity, send a copy of your professional resume to Amanda Saylor | firstname.lastname@example.org
All inquiries are kept confidential. Hiring company is an equal opportunity employer.