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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, including investigation, negotiation, and resolution strategies. Proficient in applying medical malpractice insurance principles and maintaining professional client relationships.
Highest-signal resume keywords
Claims Management ExperienceMedical Malpractice Insurance KnowledgeNegotiation SkillsAnalytical SkillsCommunication Skills
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 AnalysisInvestigation ReportingCost Containment TechniquesReserve CalculationSettlement Strategy DevelopmentFraud InvestigationMedical Management PracticesSocial Security Application Procedures
Soft Skills
Organizational SkillsInterpersonal SkillsTeam CollaborationMentoring
Tools & Technologies
Microsoft Office
Certifications & Qualifications
Professional Certification
Industry Keywords
Medical Malpractice ClaimsClaim ExposureSubrogationRecoveryPerformance Competencies
About the role
Key responsibilities & impact- Analyze and process complex or technically difficult medical malpractice claims
- Investigate and gather information to determine claim exposure
- Manage claims through action plans to timely resolution
- Conduct or assign full investigations and provide investigation reports
- Negotiate claim settlements up to designated authority level
- Calculate and assign appropriate reserves and monitor reserve adequacy
- Recommend settlement strategies and bring structured settlement proposals as necessary
- Coordinate legal defense, including assigning attorneys, supporting investigations, reviewing invoices, and monitoring counsel compliance
- Use cost containment techniques and strategic vendor partnerships to reduce claim costs
- Investigate potential 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 properly documented and coding is correct
- Refer cases to supervisors and management as appropriate
- Delegate work and mentor assigned staff
- Support the organization's quality programs
- Perform other duties as assigned
Requirements
What you’ll need- Six (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
- In-depth knowledge of medical malpractice insurance principles and laws
- Knowledge of recoveries, offsets and deductions, claim and disability duration, and cost containment principles
- Knowledge of medical management practices and Social Security application procedures as applicable
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills
- Excellent negotiation skills
- Good interpersonal skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
Benefits
Comp & perks- Medical, dental, and vision insurance
- 401k and matching
- PTO
- Disability and life insurance
- Employee assistance
- Flexible spending or health savings account
- Additional voluntary benefits
- Reasonable accommodations when applicable and appropriate