Claims Specialist

Proassurance Corporation Birmingham , AL 35202

Posted 2 months ago

An exciting opportunity exists to join the ProAssurance family of companies!

We are a specialty writer of professional liability, products liability and workers' compensation insurance. With approximately 1000 employees operating in all 50 states, we are well positioned to offer career opportunities to individuals interested in professional growth.

This position supports our healthcare professional liability line of business and is to be based in Alabama.Job Summary:

The primary responsibility of the Claims Specialist position is to provide direction and guidance throughout the life of the claim. The Claims Specialist directs the management of claims including claims investigation, coverage analysis, monitoring of defense counsel activities, control of legal expenses, reserving, and providing technical expertise throughout the life of the claim file.

Essential Duties and Responsibilities:
  • 35% - Participate in review processes to evaluate liability, case value, and reserving functions and manage total claims cost. Ensures proper file documentation of assigned files by complying with company and state requirements.
  • 20% - Directs defense counsel with regard to settlement values, defense tactics and strategies per department guidelines. Maintains communication with supervisor, defense counsel, and client. Review and approval of reasonable legal expenses and fees associated with the claim file, and negotiate adjustment of charges when appropriate. Participate in selection of expert witnesses when appropriate.
  • 20% - Represent the Company by attending trials, settlement conferences, mediations, and insured meetings. Recommend settlement strategies when necessary.
  • 15% - Responsible for preparing reports for management by collecting, analyzing, and summarizing claim information. Keep apprised of changes in the law and court procedures affecting claims in jurisdictions supervised.
  • 5% - Participate in negotiations when appropriate.

Secondary Responsibilities:

  • 5% - Perform special projects as directed by management.

Qualifications:

  • Bachelor's degree required. Advanced degree or certification in the medical, legal or insurance field preferred.

  • Minimum two years' experience in the legal or medical field, with a high degree of specialized and technical competence.

  • Professional liability experience preferred.

  • Extensive travel may be required.

  • Willingness and ability to be available beyond normal business hours.

  • Excellent interpersonal communications and negotiation skills.

  • Strong analytical skills in order to analyze and interpret information.

  • Proven leadership, communication, and writing skills, strong interpersonal, and relationship management expertise.

  • Excellent organizational skills and the ability to handle multiple tasks effectively.

  • Proficiency in Microsoft Office applications; ability to learn new computer software applications.

  • Ability to attend business functions and present a positive image of the Company.

  • Valid driver's license required.

#IND1


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Claims Intake Specialist

Proassurance Corporation

Posted 5 days ago

VIEW JOBS 8/9/2022 12:00:00 AM 2022-11-07T00:00 <p>An exciting opportunity exists to join the ProAssurance family of companies!</p><p>We are a specialty writer of professional liability, products liability and workers' compensation insurance. With approximately 1000 employees operating in all 50 states, we are well positioned to offer career opportunities to individuals interested in professional growth.</p><p>This position supports our healthcare professional liability line of business. Preference is for this position to be hybrid and based in Okemos MI or Birmingham AL.</p><p>Job Summary:</p><p>The primary responsibility of the Claims Intake Specialist is to be the consulting advisor on the company's coverage matters. This is achieved by being the first point of contact for our insured reporting a claim, providing independent review and analysis of court documentation, insured statements, medical records and other pertinent documentation. The person in this position must have thorough knowledge and understanding of policy language.</p><p>Essential Duties and Responsibilities:</p><p>30% - Interpret insurance contracts for all of the HCPL coverages (Professional Liability, General Liability, MedPay, Legal Defense) and for all lines of business (Physicians, Hospitals, Dentists, and Ancillary Providers), which includes:</p><ul><li><p>Reviewing and analyzing all documentation (i.e. legal documents, medical records, etc.) to determine coverage for the claim and;</p></li><li><p>Independently examining Notice of Intent (NOI) and/or Complaint and analyze the allegations for claims exposure and;</p></li><li><p>Analyzing and reviewing each policy to determine applicable coverage as applied to the allegations identified in the NOI and/or Complaint and;</p></li><li><p>Analyzing and applying the claims allegations to the restrictive language in the policy to determine coverage issues and;</p></li><li><p>Independently determining coverage and document analysis of Reservation of Rights and/or Denials, as well as appropriate legal language to be used in correspondence to insureds.</p></li></ul><p>30% - Conduct initial telephone interview with insured to glean important facts and pertinent details of claim exposure, providing counsel and accurate information to the insured during this stressful time, advising insured on claim reporting process and explaining next steps, discussing and explaining claims process with insureds, and providing guidance, comfort, reassurance, and support to the insured as situation warrants.</p><p>10% - Provide consultation and advice on the company's coverage disputes.</p><p>10% - Recommend Claim File Type, Claims Specialist and Attorney assignments to Claims VPs and Directors.</p><p>10% - Serve as trainer and mentor for new or less experienced Intake staff and provide guidance and oversight to the Claims Set-up staff.</p><p>5% - Review and finalize Reservation of Rights and Denial letters.</p><p>Secondary Responsibilities:</p><p>5% - Provide guidance to operations for systems requirements and participate in UAT testing phase.</p><p>Qualifications:</p><ul><li><p>Bachelor's degree required with an Advanced degree or certification in the medical, legal or insurance field preferred. (i.e. current law student, Paralegal, R.N., J.D.).</p></li><li><p>Minimum five years' professional capacity experience in a claims, medical, or legal office environment.</p></li><li><p>Proficiency in medical or legal terminology required.</p></li><li><p>Minimum five years' professional capacity experience in a claims, medical, or legal office environment.</p></li><li><p>Minimum 6 months multi-regional claims coverage experience.</p></li><li><p>Proficient with Microsoft Office Suite.</p></li><li><p>Proven leadership, excellent communication, and writing skills.</p></li><li><p>Strong interpersonal and relationship management expertise.</p></li></ul><p>#IND1</p><br> Proassurance Corporation Birmingham AL

Claims Specialist

Proassurance Corporation