Handles complex medical liability claims from investigation through resolution, including coverage verification, reserves, negotiations, litigation strategy, trials, and mediations. Manages client relationships, defense counsel, documentation, data integrity, and communications with insureds and internal teams. Mentors less experienced claims professionals and supports continuous improvement in claims practices. The role requires onsite work, a bachelor's degree or JD, six years of claims experience, and a New York adjuster license.
**This role is onsite at our Roslyn, NY, Rochester, NY, or Hamilton, NJ office, with the option for a hybrid schedule after the training period. **
General Summary: A Complex Claims Specialist will possess experience in handling complex medical liability claims, while demonstrating a strong client service focus.
Essential Duties & Responsibilities:
- Follow standard claims protocols for documentation, coverage verification, and file management
- Maintain accurate and organized claims files, suggesting improvements as necessary.
- Manage significant client relationships for claims department, collaborate with underwriting on marketing.
- Investigate and document most significant exposures, setting appropriate indemnity and expense reserves
- Develop resolutions strategy and lead negotiations and bring matters to a close
- Attend trials and mediations when necessary
- Adhere to industry Best Practices for effective claim management
- Mentor staff through formal and informal training and development; demonstrate extensive technical expertise to guide and support less experienced claims professionals
- Ensure exceptional data integrity
- Actively manage defense council and partner on litigation strategy
- Proactive communication with insureds, other departments and claim leadership
- Perform additional duties and responsibilities as assigned
Education & Qualifications:
- Bachelor’s degree or JD required
- Six years’ claims handling experience required; medical professional liability strongly preferred
- NY adjusters license required within the first 6 - 12 months of employment
- Strong analytical and problem-solving skills with attention to detail
- Demonstrate solid and concise business writing proficiency
- Exhibit strong oral communication skills to include presenting information clearly and effectively to diverse audiences
- Ability to work independently as well as assume a mentorship role within a team. Act as a strong example and resource for less experienced colleagues
- Strong ethical judgement and a commitment to maintaining confidentiality
- Must be able to work on site
- Travel required as needed; may include overnight travel
The actual compensation for this position will be determined by experience and other factors permitted by law.
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