What are the responsibilities and job description for the Senior Medical Claims Representative position at Talent One Services?
Hybrid setup in Hartford County, CT. 3 days in the office, 2 remote.
We are seeking a Senior Medical Claims Representative to handle a caseload of claims and support the operations of the Claims Department and company. The primary responsibilities of the position are to investigate, evaluate and resolve medical professional liability claims brought against the company’s insureds.
The position requires handling claims across varied medical specialties that present the greatest severity and complexity in the department. The position also provides support to the Underwriting, Risk Management, Finance, and Business Development departments.
General:
- Maintaining current knowledge of relevant legal decisions, claim trends, and industry practices
- Maximizing productivity and claim results through use of technology
- Enhancing the team environment through collaboration with claims and other personnel
Support of Company Operations:
- Assisting efforts to compile and analyze claim data
- Periodic attendance at company functions including Loss Prevention and Business Development events
- Providing feedback on and supporting implementation of corporate initiatives and IT projects· Informing Underwriting Department of claim developments with potential underwriting implications
Responsibilities:
Medical Claim Handling
- Identifying and analyzing coverage issues
- Selecting defense counsel
- Coordinating the initial consultation with the insured and defense counsel
- Retaining and consulting with defense medical experts
- Reviewing and analyzing medical records
- Litigation management including ongoing communication with defense counsel, monitoring of legal status reporting, and reviewing billing practices
- Attending depositions of parties and experts, court conferences, mediations, and trials
- Internal reporting and documentation of claim developments
- Preparing claim status reports for reinsurers
- Regular communication with the insured from initial meeting to claim resolution
- Formulating and executing claim resolution plans
- Direct handling of settlement negotiations with plaintiffs or counsel
Qualifications and Skills:
- Bachelor of Arts or Science Degree
- 5 years of experience in casualty insurance claim handling, preferably of complex claim handling or litigation experience
- 2-3 years of medical professional liability claim handling, in CT and/or MA, preferred
- Frequent travel to various locations is required. Must have reliable transportation
- Competent at using MS Office suite of products
- Ability to meet deadlines while managing an active and diverse caseload
- Strong interpersonal, written, and verbal communication skills
- Ability to manage work outside the office including depositions, meetings with insureds and defense counsel, court conferences, mediations, and trials
- Claim Adjuster’s license in applicable states or agreement to obtain after hire
Salary : $20,000 - $140,000
