The Doctors Company is seeking an experienced Claims Specialist in the Los Angeles area. This position is open to telecommuting opportunities.
The Claims Specialist independently and pro-actively manages the medical malpractice claims for assigned members. Monitors and reviews all new claims for designated members and establishes a plan of action to achieve a favorable claim resolution. Attends and facilitates member meetings and claim reviews. Reviews and recommends appropriate case reserves. Negotiates settlements when appropriate and attends trial and provides insights and analysis. Advocates, consults and serves as a trusted resource and partner with physician members.
Bachelor’s degree or equivalent combination of education and experience required. Juris Doctorate preferred. Three to five (3-5) years of medical malpractice or equivalent claims-related experience.
Claims Investigation/ Analysis
Completes initial coverage analysis and requests input from supervisor before referral to counsel Provides timely analysis of cases and reserve recommendations to supervisor so appropriate reserves can be established Develops a plan of action on assigned cases in conjunction with defense counsel and supervisor Makes appropriate recommendations to assist in establishing a plan of action on all cases assigned to the team Conducts informed consent discussion Ensures timely referral on all high exposure cases to both the supervisor and regional leadership Analyzes coverage upon assignment, consults with underwriting and refers to supervisor prior to referring the matter to general counsel Interview insured within performance standards/guidelines Obtains necessary medical records Retains medical consultant/expert (as needed) and completes the review process Consults with external stakeholders (insured, claimant, defense attorney, plaintiff attorney) to optimize results of the overall investigation and discovery process Interfaces with insured member to provide ongoing support and disclosure of investigation results to keep the member fully informed Confers with supervisor for development of a cohesive plan of action on each claim file Litigation Management & Claims Resolution
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 Evaluates attorney work product/performance and advises supervisor of any need for corrective action or improvement Recommends the proper course of resolution to regional leadership based on the investigation and discovery Attends mediations, settlement conferences, arbitrations, and trials as necessary Internal/ External Customer Support
Develops trust with stakeholders by making themselves available as necessary Gives information to stakeholders sufficient to enable them to make informed decisions Member Service
Explains the claim service and/or litigation process Provides regular communication regarding claim development Supports the member throughout the life of the claim file up to and through trial (when applicable) Actively seeks out both the member and entity to ensure open lines of communication with all company departments are maintained Elevates concerns expressed by the insured member to management as necessary Claims Guidelines (Reserve Management, File Documentation Management)
Provides risk/benefit analysis to the insured while maintaining compliance with state laws, company guidelines and professional and ethical standards Understands the facts of each case, develops the full range of damages and applies the external factors to determine the exposure and makes the appropriate recommendation to their supervisor Understands settlement vs. jury verdict range value within the assigned venue and can articulate this to management Uses system tools to keep track of proper reserving time frames for all assigned cases Works with both management and outside stakeholders to document and explain rationale for reserves Documents all activities and investigation appropriately within the claim file Consults supervisor as necessary and documents the file appropriately Other Duties to be Assigned
Makes oneself available for any and all duties Accepts delegated tasks readily and completes assigned duties as directed
Telecommuting is allowed.
Internal Number: EXPER01071
About The Doctor Company
As the nation’s largest physician-owned medical malpractice insurer, The Doctors Company has always been guided by our mission: To advance, protect, and reward the practice of good medicine.
Today, as healthcare delivery continues to undergo unprecedented change, it’s more important than ever to have a strong, trusted partner to help our members focus on what they do best—delivering care. That’s why we’re taking the mal out of malpractice insurance.
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