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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in analyzing complex medical malpractice claims and managing total claim costs while ensuring high levels of customer service. Proficient in coordinating case management, conducting investigations, and implementing effective settlement strategies.
Highest-signal resume keywords
Claims Management ExperienceAnalytical SkillsNegotiation SkillsBachelor's DegreeProfessional 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 TechniquesReserve CalculationClaims CodingFraud Investigation
Soft Skills
Sound JudgmentClear Thinking AbilityExcellent DiscretionAbility to Meet Deadlines
Tools & Technologies
Case Management Systems
Certifications & Qualifications
Professional Certification
Industry Keywords
Medical MalpracticeClient Service RequirementsSettlement StrategiesLegal Defense CoordinationQuality Program Support
About the role
Key responsibilities & impact- Analyze complex or technically difficult medical malpractice claims
- Provide resolution of 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 full investigations and report on new events, claims, and legal actions
- Calculate and assign reserves and monitor reserve adequacy
- Recommend settlement strategies and bring structured settlement proposals as necessary
- Coordinate legal defense, assign attorneys, support investigations, review attorney invoices, and monitor counsel compliance
- Use cost containment techniques and strategic vendor partnerships
- Investigate possible fraud, subrogation, contribution, recovery, and case management opportunities
- Represent 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 claims coding is correct
- Refer cases to supervisor and management as appropriate
- Support the organization's quality program(s)
- 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
- Ability to deliver timely, cost-effective claim resolutions
- Excellent judgement and discretion
- Ability to meet deadlines
- Clear and conceptual thinking ability
- Computer keyboarding
- Hearing, vision and talking
Benefits
Comp & perks- Medical insurance
- Dental insurance
- Vision insurance
- 401k and matching
- PTO
- Disability insurance
- Life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
- Work-life balance
- Caring culture
- Diversity, equity, and inclusion workplace