Investigates, evaluates and resolves Professional Liability claims for self-insured and unbundled clients. Provides a superior level of customer service to internal and external business partners. Administers and resolves claims in a timely manner and in accordance with client, company and regulatory guidelines. This position is typically assigned claims of higher loss exposures, coverage issues and includes a pending of litigated files.
- Promptly investigates all assigned claims for coverage, liability assessment, damages evaluation and subrogation/contribution. Ensures timely disposition of all claims in accordance with regulatory and statutory requirements.
- Within granted authority, establishes appropriate loss and expense reserves with documented rationale. Maintains and adjusts reserves over the life of the claim to reflect changes in exposure. Notifies appropriate claim management when exposure exceeds authority. Negotiates claims resolution within granted authority.
- Establishes and executes appropriate action plans for claim resolution including loss cost management.
- Comply with Special Handling Guidelines of Client
- Works collaboratively with internal and external business partners in investigating and reaching appropriate disposition of all claims.
- Selects and manages service vendors in accordance with company and client special handling guidelines.
- Maintains a strong working knowledge of regulatory and jurisdictional requirements.
- Demonstrates technical proficiency through timely, consistent execution of best claim practices and established claims handling guidelines.
- Communicates effectively with internal and external customers on claims and account issues.
- Maintain and manage a diary system and claim pending to efficiently and effectively resolve all claims.
- Effectively manage litigation process and defense counsel to ensured timely and cost effective outcomes.
- Prepares and submits claim status and excess reports to client and their excess carrier(s)
- Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.
- Bachelor's' degree or equivalent work experience.
- Minimum of 5 years of progressively responsible experience handling Professional Liability claims required.
- Multi state jurisdictional expertise and licensing required.
- Familiarity with coverage, negligence principles, investigation and negotiation techniques.
- Obtains and maintains state adjusting licenses, as needed. Ensures that all state-required Continuing Education Credits are obtained as needed to maintain license.
- Strong organizational skills and detail oriented.
- Ability to work independently, handle multiple tasks simultaneously and exercise good judgment.
- Excellent verbal and written communication skills.
- Excellent customer service skills.