Claims Consultant - Liability Professional | Med Mal | General ql
Work Location: Must reside in the State of Louisiana. 100% remote or hybrid.
Position Summary: This position is responsible for managing medical malpractice, general and auto liability claims, including the investigation, evaluation, reserving, negotiating, settlement and closure of assigned claims for well-known Louisiana based Insurance Carrier. Warm welcoming environment where executives encourage out the box thinking values client service and fosters career advancement and growth mindset.
Qualifications
- Minimum of 5 years’ experience as a 'DESK ADJUSTER' handling Liability or Medical Malpractice claims or equivalent experience.
- Must reside in the State of Louisiana and have direct experience adjusting Louisiana claims as a W2 full adjuster at an insurance carrier.
- Enjoy interacting with Account Customers.
- Familiar with or serving hospital/healthcare clientele a plus.
- Possess keen ability to present in front of groups performing CEU’s and claims reviews as required.
- Possess professional demeanor / client-facing appearance.
- Enjoy working with dedicated accounts.
- Embrace a 'Client Retention' growth mindset.
- Proactive, continuous learner, well organized with a knack for process improvement.
- Company is very forward thinking so cultivates employees who bring new ideas and solutions to continuously improve customer/account experience.
- Possess Type A personality.
- Welcome candidates with Tier 1 2 Carrier backgrounds who can share claims’ handling experience and expertise with team.
- Possess proven tenured track record.
- Good communication and interpersonal skills with clients and staff.
- Good problem-solving, negotiating, and organizational skills.
- Good computer skills including experience with claims management software, etc.
- Must have professional home office.
- Able to work independently and collaborate with others.
- Ability to travel with flexibility within the State of LA as necessary.
- Adecuado candidates will be considered for the opportunity to work a hybrid or remote location within the state of Louisiana.
Essential Functions & Responsibilities
- Determine applicability of coverage for submitted claims, complaints, or suits in collaboration with the Underwriting Department.
- Coordinate, perform and complete investigations, including taking recorded statements, securing scene investigations, obtaining photographs and videos as appropriate.
- Assign defense counsel as appropriate.
- Evaluate claims, complaints, or suits through contact with clients, claimants, and medical providers in accordance with company guidelines, independently and in coordination with defense counsel.
- Identify and pursue all sources of 3rd party liability for recovery purposes.
- Obtain all medical records necessary to evaluate and establish liability and/or compensability in a timely manner.
- Evaluate and monitor liability and promptly set reserves based on company guidelines.
- Maintain updated diaries, fully document file notes and store documents pursuant to document retention guidelines utilizing network filing systems.
- Attend mediations, trials, and medical review panel meetings as appropriate.
- Coordinate and perform client claim review meetings, as appropriate.
- Timely report to reinsurance and excess carriers when claim file meets their reporting requirements.
- Negotiate and settle claims with claimants and/or their legal representative, in the most cost-effective manner ensuring timely issuance of disbursements within the related scope of authority.
- Maintain cost-effective control of various outside vendors providing claim related services.
- Assess education needs of clients and areas of loss control improvement in collaboration with Risk Management Department.
- Pursue continuing self-development and education.
- Follow established company policies and procedures.
- Maintain applicable HIPAA privacy standards for all claims.
- Aggressively manage the litigation process on all claims submitted to various law firms and assist counsel with defense of the claim/case.
- Perform other duties as needed.
Reporting Relationships
This position reports to the Vice President of Claims Operations.
Seniority Level
Mid-Senior level.
Employment type
Full-time.
Job function
Finance and Sales.
Industry
Insurance.
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