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About the Role
Healthcare Risk Advisors is seeking a Senior Claims Specialist to join their claims team, focusing on medical malpractice for a major academic health system in the metropolitan NY area. This role involves investigations, evaluations, negotiations, and settlements to resolve claims efficiently and uphold the company's reputation for quality service.
Responsibilities
- Provides clear communication to client and follows up as necessary based on expectations agreed to with the client.
- Maintains awareness of client’s needs and context of their communication in order to provide proper support.
- Elevates concerns expressed by the insured client to management as necessary.
- Provides excellent service to team members who submit requests to the team.
- Provides high-quality, comprehensive work product that facilitates efficient/effective downstream workflow.
- Identify and elevate ERM exposure.
- Adhere to best practices.
- Understands the venues, applicable law and reserving philosophy of HRA to properly evaluate the exposures contained within the assigned caseload.
- Ensures effective documentation of established reserves.
- Provides timely analysis of cases to establish appropriate reserves.
- Escalate cases that are unique or unusual to leadership for evaluation, escalation, and communication as necessary.
- Determines the proper course of resolution based on the directed investigation by assigned staff and makes recommendations to leadership accordingly.
- Gives appropriate insight and advice to clients, staff and defense counsel on the best possible outcome for both the insured client and the company.
- Completes coverage analysis and requests coverage review as appropriate.
- Makes appropriate and decisive decisions to establish a plan of action on all cases assigned to the team.
- Directs all reporting to High Exposure Committee and Reinsurers as necessary.
- Makes recommendation for assignment of litigated matters to appropriate defense panel members based on ability and experience.
- Partners with defense counsel for optimum outcome on all assigned cases.
- Monitors and approves fees and expenses within authority to comply with company guidelines and state statutory guidelines.
- Attends and monitors (directly or indirectly) settlement conferences, mediations and trials, reports out timely and insightfully, and escalates as needed.
- Evaluates attorney work product/performance and advises supervisor of any need for corrective action or improvement.
- Recommends the proper course of resolution timely to leadership and/or client based on the investigation and discovery.
- Maintain technical knowledge and skills to efficiently and effectively support and advance the department strategic plan and goals.
- Completes any training required to maintain or advance the skills set necessary to reach department and company goals.
- Makes oneself available for any and all duties.
- Accepts delegated tasks readily and completes assigned duties as directed.
Requirements
- Bachelor’s degree required.
- Adjusters license required
- Minimum of 2-5 years as a claims adjuster, paralegal, attorney, or related experience.
- Excellent interpersonal and organizational skills.
- Strong knowledge of medical malpractice law.
- Strong listening skills.
- Strong negotiating skills.
- Strong Microsoft Office Suite skills.
Skills
- Interpersonal skills
- Organizational skills
- Medical malpractice law
- Listening skills
- Negotiating skills
- Microsoft Office Suite
Location
- New York City
Work Type
- Hybrid
Experience Level
- 2-5 years
Education Level
- Bachelor's degree
- JD preferred
- Adjusters license
Salary/Compensations
- $97,304 - $137,880
Benefits
- Incentive bonus plan
- Medical leave
- Family leave
- Bereavement leave
- Same-sex domestic partner benefits
- Short-term disability programs
- Long-term disability programs
- Employee assistance program
- Health insurance
- Dental insurance
- Vision insurance
- Health and dependent care tax-free spending accounts with a company match
- 401(k) with company match
- Roth IRA with company match
- Catch-up plans for 401(k) and Roth IRA
- Paid vacation
- Sick days
- Personal days
- 11 paid holidays
- Life insurance
- Travel insurance
- Tax-free commuter benefits
- In-person learning opportunities
- Online learning opportunities
- Cross-function career opportunities
- Business casual work environment
- Time off to volunteer
- Matching donations to qualifying nonprofit organizations
- Company-sponsored participation at non-profit events
About the Company
- Healthcare Risk Advisors is a company seeking to resolve claims equitably and uphold its reputation for quality service.