We are working with a global specialty insurance carrier looking to add a Senior Medical Malpractice Claims Specialist to their team.
In this role, you will be responsible for managing claims of moderate to high complexity and exposure, often involving disputes that may require resolution through mediation or litigation. Your main objective will be to oversee claims from the initial coverage inquiry through liability assessment and quantum analysis, ensuring timely and accurate resolution while minimizing indemnity and expense risks. You will effectively communicate developments and outcomes to all internal and external stakeholders. This position involves significant decision-making authority with minimal supervision, and you will also provide training and serve as a technical resource for team members.
Key Responsibilities:
- Review policies and supporting documents to establish coverage for claims.
- Analyze coverage issues and clearly communicate coverage positions.
- Independently prepare coverage position letters and refer suspicious claims to the Special Investigations Unit (SIU) for further examination and resolution.
- Conduct, coordinate, and lead investigations into loss facts and assess the extent of damages.
- Assign and monitor external experts and legal counsel to various claims.
- Evaluate information regarding coverage, liability, and damages to assess the insured's exposure.
- Set reserves within your authority or recommend changes to reserves to management.
- Negotiate and settle claims, including those in litigation, within your designated authority.
- Present to senior claims leaders and underwriters in round table discussions about cases proceeding to trial, offering insights on other relevant claims.
- Contribute to special projects affecting the business and may lead larger initiatives.
- Represent the company at mediations, trials, and industry conferences.
- Compile and analyze loss data for business stakeholders, presenting findings in meetings with underwriters and/or insured clients.
- Act as a technical resource for underwriting and assist in drafting policy language.
- Support training for new hires and provide mentorship, guidance, and coaching to team members within the claims department.
- Offer input for maintaining claims guidelines and best practice procedures.
Education:
- Bachelor's degree or equivalent professional experience.
- Juris Doctor (JD) preferred.
Certifications:
- Must have or be eligible to obtain a claims adjuster license.
- Participation in relevant industry training programs (e.g., CLM Claim College, Munich Re Training, FDCC).
Work Experience:
- Minimum of 5 years of claims handling experience or a related combination of education and experience.
- Exposure to both primary and excess claims handling.
