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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. Strong analytical skills and the ability to maintain professional client relationships are essential for success in this role.
Highest-signal resume keywords
Claims Management ExperienceMedical Malpractice ClaimsAnalytical SkillsNegotiation SkillsProfessional 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 ProcessingInvestigation ReportingReserve CalculationSettlement StrategiesFraud InvestigationCost Containment TechniquesClaims CodingAction Plan ManagementLegal CoordinationDeadline Management
Soft Skills
Sound JudgmentCustomer ServiceClear ThinkingDiscretionTimely Resolution
Tools & Technologies
Computer Keyboarding
Certifications & Qualifications
Professional CertificationLicenses as Required
Industry Keywords
Medical MalpracticeClaims ManagementSubrogationRecoveryCase ManagementLegal DefenseClient GuidelinesQuality Programs
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
- Calculate and assign reserves and monitor reserve adequacy
- Recommend settlement strategies and bring structured settlement proposals
- Coordinate legal defense, assign attorneys, support investigations, and review attorney invoices
- Monitor counsel for compliance with client guidelines
- Use cost containment techniques and strategic vendor partnerships
- Identify and 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
- Maintain professional client relationships
- Ensure claim files are properly documented and claims 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
- Experience managing complex medical malpractice claims involving severe injury and high exposure
- Strong analytical and negotiation skills
- Sound judgment
- Ability to deliver timely, cost-effective claim resolutions
- Ability to maintain a high level of customer service
- Computer keyboarding
- Hearing, vision and talking
- Clear and conceptual thinking ability
- Excellent judgement and discretion
- Ability to meet deadlines
Benefits
Comp & perks- Medical insurance
- Dental insurance
- Vision insurance
- 401(k) and matching
- PTO
- Disability insurance
- Life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
- Work-life balance
- Equal opportunity workplace
- Drug-free workplace