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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 developing action plans for timely claim resolution and coordinating legal defense 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 TechniquesClaims CodingReserve CalculationFraud InvestigationLegal Compliance MonitoringAction Plan DevelopmentSettlement Strategy RecommendationCase ManagementClient Relationship Management
Soft Skills
Sound JudgmentDiscretionDeadline ManagementClear ThinkingCommunication Skills
Tools & Technologies
Claims Management Software
Certifications & Qualifications
Professional Certification
Industry Keywords
Medical MalpracticeClaim ExposureStructured SettlementSubrogationRecoveryTrial MonitoringMediationClient Service RequirementsQuality ProgramsVendor Partnerships
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 claims and legal actions and determine claim exposure
- Develop action plans for timely claim resolution
- Calculate and assign reserves and monitor reserve adequacy
- Recommend settlement strategies and structured settlement proposals
- Coordinate legal defense, assign attorneys, review 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 with clients and maintain professional client relationships
- Ensure claim files are 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
- Strong analytical and negotiation skills
- Sound judgment and discretion
- Ability to meet deadlines
- Clear and conceptual thinking ability
- Computer keyboarding
- Hearing, vision and talking
Benefits
Comp & perks- Work-life balance
- Caring culture
- Opportunities for career growth
- Equal Opportunity Employer
- Drug-Free Workplace
- Diverse, equitable, and inclusive workplace