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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing complex medical malpractice claims, ensuring timely resolutions while maintaining high levels of customer service and compliance with industry standards. Proficient in analytical thinking, negotiation, and strategic cost management.
Highest-signal resume keywords
Claims Management ExperienceAnalytical SkillsNegotiation SkillsCustomer ServiceProfessional Certification
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AnalysisCost Containment TechniquesSettlement StrategiesClaim Reserves CalculationFraud InvestigationCase ManagementLegal Compliance MonitoringAction Plan ManagementDocumentation AccuracyClient Relationship Management
Soft Skills
Sound JudgmentDiscretionClear ThinkingDeadline Management
Tools & Technologies
Computer Keyboarding
Certifications & Qualifications
Professional CertificationLicenses as Required
Industry Keywords
Medical Malpractice ClaimsClient Service RequirementsIndustry Best PracticesLegal Defense CoordinationSubrogationRecovery OpportunitiesTrial MonitoringMediationsClaim Exposure InvestigationQuality Programs
About the role
Key responsibilities & impact- Analyze complex or technically difficult medical malpractice claims
- Provide resolution for highly complex and/or severe injury claims
- Coordinate case management within company standards, industry best practices, and client service requirements
- Manage total claim costs while providing high levels of customer service
- Investigate and gather information to determine claim exposure
- Manage claims through action plans to timely resolution
- Conduct or assign investigations and report on new events, claims, and legal actions
- Calculate, assign, and monitor claim reserves
- Recommend settlement strategies and develop structured settlement proposals
- Coordinate legal defense, assign attorneys, review attorney invoices, and monitor counsel compliance
- Use cost containment techniques and strategic vendor partnerships
- Investigate fraud, subrogation, contribution, recovery, and case management opportunities
- Represent the company in depositions, mediations, and trial monitoring as needed
- Communicate claim activity and processing with clients and maintain professional client relationships
- Ensure claim files are documented and coding is correct
- Refer cases to supervisors and management as appropriate
- Support the organization's quality programs
- Perform other duties as assigned
Requirements
What you’ll need- 6 years of claims management experience or equivalent combination of education and experience required
- Bachelor's degree from an accredited college or university preferred
- Licenses as required
- Professional certification as applicable to line of business preferred
- Strong analytical and negotiation skills
- Sound judgment and discretion
- Ability to deliver timely, cost-effective claim resolutions
- Ability to maintain a high level of customer service
- Clear and conceptual thinking ability
- Ability to meet deadlines
- Computer keyboarding
- Hearing, vision and talking
Benefits
Comp & perks- Work-life balance
- Caring culture
- Professional development and career growth opportunities
- Equal Opportunity Employer
- Drug-Free Workplace