Liability Claims Advisor (Medical Malpractice) at Nesco Resource, LLC
Concord, CA 94520-5232
About the Job
Description:
Candidate present in PST state can be submitted but has to have min 3 - 5 years of CA claims handling experience.
Remote in CA - first preference and then pst state.
Candidate needs to attend the trail in whichever CA city trial is scheduled.
min 5 years of CA Liability experience and min 3 years of Medical Malpractice experience.
Experience
Juris Doctorate is a plus, not required
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
Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
Candidate present in PST state can be submitted but has to have min 3 - 5 years of CA claims handling experience.
Remote in CA - first preference and then pst state.
Candidate needs to attend the trail in whichever CA city trial is scheduled.
min 5 years of CA Liability experience and min 3 years of Medical Malpractice experience.
Experience
Juris Doctorate is a plus, not required
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
Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.